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14 tt (� � � Y �v y tf7a� <br /> Please print or type. (Form designed for use on elite (T2-pitch) typewriter.) Form Approved. OMB No, 2050-0039 <br /> UNIFORM HAZARDOUS 1 . GeneralorlDNumber 2. Pagel of 3. Emergency Response Phone4, ManifetTrackin Number <br /> WASTE MANIFEST CA L k3 13 s3 4 .[1 X 5 9 5 1 ( 800) 424 _ 9300 911116622 JJK <br /> 5, Generators Name and Mailing Address Generators Site Address (if i itierent than mailing address) <br /> ARAMIAPK <br /> 7079 S. LONGE ST. <br /> STOCKTON ('-A 95200 <br /> Generators Phone: ( 2Ci9) 234" <br /> 6.jTraranspoprter 1 Company Name U.S. EPA ID Number <br /> 7.Tmnspoder2 Company Name 0.S. EPA I0 Number <br /> B. Designated Facility Name and Site Address U.S. EPA ID Number <br /> CHEMCAE YVA,STE MANAGEMENT, INC, <br /> 35251 OLD SKYLINE ROAD C A V 0 0 0 6 4 E 1 1 7 <br /> (-CET iLEMAN CITY CA 03239 <br /> Factitys Phone: <br /> 909b. U.S. DOT Descdpfion (including Proper Shipping Name, Hazard Class, ID Number, 10. Conminam 11. Total 12. Unit 13. Waste Codes <br /> HM and Packing Group (dany)) No. Type Quantity WtNol. <br /> Q <br /> NON RCRAHAZARC1C�US WASTE SCUD � <br /> to 2�d <br /> � 1 <br /> 3. <br /> ` C <br /> 4_ <br /> 14. Special Handlin Instructions and Additional Information1 . CAO 8852 <br /> CHENITRECCONTRA,CT CN24417 <br /> Ah <br /> 15, GENERATOR'SfOFFEROWS CERTIFICATION: I hereby declare that the contents Of his consignment am fully and accurately described above by the mopershipping name, and are classified, packaged, <br /> marked and labeledlplacarded, and are In all respects in proper condition for transport according to applicable international and national governmental regulations. if export shipment and l am the Primary <br /> Expdder, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I codify that the waste inlnimization statement identified In 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifI am a small quantity generator) is he. <br /> G �rslglfemts PrinledfTyped Name Month Day Year <br /> .r 16. International Shipments <br /> i— ❑ Importto U.S. ❑ Export from U.S. Port ofentry/exit: <br /> Transporter signature (for exports only): Date leaving U'S': <br /> 17. TransporterAcknewledgmenl of Receipt of Materials <br /> Month Da Year <br /> tE Transporter l Printedlryped N vie Signator Y <br /> QTransporter 2 Printedffyped No Signature Month Day lear <br /> K <br /> H <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space ❑ Quantity ❑Type ❑ Residue ❑ Partial rmectfon ❑ Full Rejection <br /> Manifest Reference Number: <br /> 18b, Alternate Facility (or Generator) - 0.S. EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 18c. Signature ofAlmmate Facility (or Generator) Month Day Year <br /> a <br /> z <br /> 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treamant, disposal, and recycling systems) <br /> w 1 2. 3. 4. <br /> 3 � <br /> 28. Designated Facility Mrier or Operator: Certification of receipt of hazer us materials covered by the manifest except as noted in Item fast <br /> Printedfryped Name Signature Mo th Day Ye r <br /> EPA Form 8700-22 (Rev3-0 reviousedition areohsclete. DESIGNATED FA09PL ® dT® DESTINATION STATE ( F REWIRED) <br />