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C'IAJMl <br /> Please print or type. (Form designed for use on elite 02-pitch) typewriter.) Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1. Generator ID Number 2. Page t of 3. Emergency Response Phone 4, Manifest Tracking Number <br /> WASTE MANIFEST tom' A L 0 0 0 4 0 5 1 ` 8001424_ 930L 011180913 JJ <br /> 5. Generalofs Name and MallinglAddress Generator's Site Address (If different than mailing address) <br /> ARAIMARK <br /> 707€ S. LONGE ST. <br /> STDCKTON CA 95201, <br /> Generator's Phone: rim qadam a I l2n <br /> 6. Transporter 1 Company. Name U.S. EPAID Number <br /> 7. Tmnsporte 2Co any Name U.S. EPA ID Number <br /> 8. Designated Facility Name and Site Address U.S. EPA ID Number <br /> CHEMICA1.`'yi7AS E MANAGEMENT, INC. <br /> 35251 OLD SKYLINE ROAD C A T 0 0 0 G 4 6 4 1 7 <br /> KETTLEMAN CITY CA 932M <br /> Fardlltys Phone: <br /> ga, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Conlalnare N. Total 12. Unit 13. Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantity . WLA7oI. <br /> 0 NON RCRAHAZARDOLISWA_TESOLID " — <br /> F <br /> � CAB08852 <br /> 3. <br /> 4. <br /> I <br /> 14. Special Handling Instructions andAdd8lonal Information - l <br /> 1 . CA008052 C•HEbATREC CONTRACTffiGC_.N21 -117 <br /> Y e �sf L1 �# tr; G <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: [ hereby declare that the contents ofthis consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> marked and labelediplacarded, and are in all respects in proper condition for Iransport according to applicable intemationaland national governmental regulations. if export shipment and I am the Primary <br /> .r Exporter, I candy that the contents of this conslgnmanl conform to the terns of the attached EPAAcknovdedgment of Consent. . <br /> I crafty that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifI am a small quanfity generator) is true. <br /> G mtoes101fic a Printedlf, of N e Signature Month Day Year <br /> —+ 16. infemaliond Shipments <br /> � [1 Import to U.S. ❑ Export from U.S. Pod ofenlry(exif: <br /> Transporter signature (for exports only): Date leaving U.S.; <br /> Lou 17. Transporter Acknowledgment of Receipt of Materials <br /> K Tmns�ioderI PdntedlTyped Name Signature Mnh Day Year <br /> o �m2q C xY l/GG/� <br /> n. . <br /> QTmnspodror2Pdnt R'yped Name Stimigaim Month Day Year <br /> K <br /> F <br /> q, 18. Discrepancy <br /> tan. Discrepancy Indication Space ❑ <br /> - - Quanfity [-]Type Residue Parfait Rejection on ❑ Full Rejection <br /> Manifest Reference Number <br /> 18b.Alternate Facility (or Generator) U.S. EPA ID Number <br /> U <br /> LL Facility's Phone: '.. <br /> w 18c. Signature ofAlfemate Facility (or Generator) A Month Day Year <br /> dLQ <br /> 0 <br /> y19. Hazardous Waste Report Management Method Codes Va., codes for hazardous waste treatment, disposal, and recycling systems) '.. <br /> 0 1. 2, 3. 4, <br /> 3�L <br /> 20. Designated Facility Owner or Operator: Certification of receipt of hazard s materials covered by the manifest except as noted In Item 18a <br /> Pdnle iffyped Name 1 Signature Mo lh :Day Y a <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions Ire obsolete. DESIGNATED FACRITYTd DESTINATION STATE (IE REQUIRED) <br />