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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No, 2050-003 UNIFORM HAZARDOUS I I. Generator ID Number 2. Page 1 of 1 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST C A L 0 0 0 4 0 5 5 9 5 74 _ 01118 0 9 0 9 JJ K 5. Generators Name and Malting Address Generator's Site Address (if different than mailing address) ARAM.ARK 7079 S, LONGE ST. STOCKTON CA95206 Generators Phone: p ,11 — Fi f1.ri 6. //nsortar l Company Name ) ` U.S. EPA IDNumber ild IAIesT: 7. Transporter 2 Company Name U.S. EPA ID Number t 8. Designated Facility Name and Site Address U.S. EPA ID Number CHEMICALWASTE MANAGEMENT, INC. 35251 ULD SKYLINE ROAN C A. 7 0 0 0 6 4 6 1 1 7 14EfTLEMA.N CITY CA 93239 Facilitys Phone: ( 650) 386- 97111 go. 9b. U.S. DOT Description (Including Proper Shipping Name, Hazard Class, ID Number, - 10. Containers 11. Total 12, Unit y 13. Waste Codes HM and Packing Group (If any)) - No. Type Quantity WtNoi. 1 1' NC1PJ RCRA: HAZARDOUS WASTE SOU D g Aw- � cA6ase52 � l Cvhl � � W 2. 3 14. Special Handling Instructions and Addifirmi Information f I . CA6178852 CHEMTREC CONTRACT #t CCN24117 15. GENERATORSIOFFEROR'SCERTIFICATION: I hereby declare that the contents Of this consignment are fully and accurately described above by the propershlpping name, and are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable International and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the tens of the attached EPAAcknowledgmenl of Consent. I certify that the waste minimization statement identified In 40 CFR 262.27(a) (if I am a large quantity generator) or (b) of l am a small quantity generator) Is We. G T tors! (firers dnted7Typed No a Signal Month Day Year o/f 127 / j 16. International Shipments i— El import to U.S, Export gave U.S. Pod ofenryrex' . z Transporter signature (for exports only): Date leaving LLS.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year GTrans poder2 PrintedAyped Name ig ore Month Day Year I � 1 r j 18. Discrepancy '1 Me. Discrepancy Indication Space ❑ Partial Re' i [I Quantity ❑ Type ❑ Residue lection ❑ Foil Rejection Manifest Reference Number. I8b.Alternate Facility (or Generator) U.S. EPA ID Number J U LL Facility's Phone: w 18c. Signature ofAlternate Facilily (or Generator) Month Day Year t— I z C) 19. Hazardous Waste Report Management Method Codes (Le., codes for hazardous waste treatment, disposal, and recycling systems) ; 1 . 77 2. 3. 4. Cr 1 20. Designated Facility Owner Or Operator. C001110tion Of receipt o hazardous materials covered by the manifest except as noted in I 18a Prinled[Typed Name Signature - Mo h Day Year t EPA Form 8700-22 (Revr -0 ) Previa seditionsareobsolete. DESIGNATED FACILITVTO DESTINATION STATE (IF REQUIREU