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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 . GenemtorlD Number 2. Pagelot 3. Emergency Response Phone 4. Manifest Tracking Nuber WASTE MANIFEST C A L 0 0 0 4 0 5 ( sari) 4 '4- 931311 011178624 JJ 5. Generators Name and Mailing Address Generator's Site•Address (if different than mailing address) ARAflAP IK 7079 S. LONGEST, S T OCKTON CA. 95206 Generator's Phone: } •�34' ' �5 6. Transporter i Company Name U.S. EPA ID Number J ' lcrieerviee� poL2 mpany Name U.S. EPA ID Number 8. Designated Facili Name and SiteAddress U.S. EPA ID Number CHEnPiSCP:LWA3TE-MAfsikGEME('411, INC, 35251OLD SKYLINE ROAD C A T 0 0 0 0 4 ft 1 1 7 KEfTLEMAN CITY CA 93239 Facility's Phone: ( 559) 38& w I I 9a 91b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers11. Total 12. Unit 13. Waste Codes ' HM and Packing Group (dany)) No. Type Quantity WLIVe. 1. NON RCRA HAZARDOUS WASTE SOLID 491 C00862 Cv 1 �I z z. � �pp 3. I 41 14. Spgcia�ad�l'pg.In3sfrJmry ons and Additional information 8U ' h .Y CHEMTREC CONTRACT *CCN24117 h��77 �9�i Lpl� �p�l 9O uC)Cae1e� '�x5 `. .r4 LI4NZr � 6 a� 15. GENERATOR'S/OFFERORS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the propershipping name, and are classified, packaged, marked and labeledlplacarded, and am In all respects in propercondi8on for transport according to applicable international and nallonal governmental regulations. If export shipment and Tam the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent, - I cagily that the waste minimization statement Idenfified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifI am a small quantity generator) is true. Ge mtarsl0ffemrs PrintedJryped Name Sign Month Day Year —r 16. International Shipments F-• ❑ Import to U.S. ❑ Expert from U.S. Pod of entrylexit: Transporter signature (for exports only): Date leaving U.S.: w 17. TranspoaerAcknowledgmentofRewiplofMatedals �I E2Lanso r 1 Printed/Typed Name Signature Month Day Year M er �1 q(efwce 11fo I Transpoder 2 Pri ad/ Typed Name 5 e Month Day Year .p 18. Discrepancy 18a, Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number 18b. Alternate Facility (or Generator) U.S. EPA ID Number � a U Facility's Phone: w 18c. Signature ofAltemate Facility (or Generator) Monty Day Year Q Z 19, Hazardous Waste Report Management Method Codes (i.e., cedes for hazardous waste treatment, disposal, and recycling systems) ® 1. 2. 3. 4. 14�f 7� 20. Designated FactityOwner or perator. Codification ofnowiptofh ardous materials covered by the manifest except as noted In Item 18 - Pdnted/ryped Name j / Signature Monty Day Year EPA Farm 8700-22 (Rev. 3-05) Previous editions fire obsolete, DEBOG MATED FACILITY TO DEST NATOON STATE (IF REQUIRED) 1