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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1. Generator ID Number 2. Page for 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST �,` E ,� .�. ;� 5 : f 0 if C! '- — 00 011180911 JJ 5. Generators Name and Mailing Address Generators Site Address (if differentiae mailing address) Al 7€ 70 S. LC5NOE ST. STOCljUO 1 CA, c5206 Generator's Phone: f 2LI91 L_ 0 1 DEE 6. Transporters Company Name s U.S. EPA ID Number Tmnsporter2mpany Name U.S. EPA ID Number 8. Designated Facility Name and Site Address - U.S. EPA ID Number CHEMICAL "JA I E MANAAGEla9ENT, INC. 35261 OLD SKYLINE ROAD CATOOO a 4 0 1 1 7 IKETTLEARAN CITY CA 93239 Facility's Phone: - 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Contalners 11. Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity WI.NoI. NON P,CR6iHAZARDOUS bASTESOLIG oa-- 1- CM088R2 z a g N m k r, 31 _�pggg t 4. 147Speclal Handling Instructions andAdd(tional Information . c�� i . C.?603852 CNEMTREC CONTRACT # CCN24117 �� !7i ✓�, $� / � �.� 1 � 15. GENERATOWSIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate'yd sA ed bove hyt propershipping name, aid are classified, packaged, marked and Iabeledflumarded, 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 allached EPAAcknowledgment 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) (fit am a small quantity generator) is true. G r�alorslORerors PrintedRy e dame sign no Mon aye Year ` � pC '' / FS 10. International Shipments I— El import to U.S ❑ Export from U.S. Pod ofentrylexit: Transporter signature (for exports only): Date leaving U.S.: w 17. TransporlerAcknovillt of Receipt of Materials Trane r1 Pdnted�/ofyp arae 7 Signzfare Month- Day Ye r I m Q mnsporter 2 Pffnitedf typed Name Si alum - Month Day Year 18.Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑T _ El ❑ Partial Rejection 1l1 YPe j ❑Full Rejection 1 Manifest Reference Number: I Or,Alternate Facility (or Generator) FU.S. EPA ID Number J U LL Facilit>•s Phone: W 18c. Signature of Alternate Facility Tor Generator) Month Day Year z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 2. 3. 4. 3 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item this 1 Pdntedfr ed Name Signature ° YP 9 Month Day Year ) �G �t e tar 1'1 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATE® FpCtLdq-y TO ®ESY1NAT1®N STATE (OF REQUIRED)