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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1 1 . Generator ID Number 2. Pae 1 of 1 3, Emergency Response Phone 4, Manifest Tracking NumberrJJ <br /> ry� <br /> WASTE MANIFEST CFaP[r[f!7'�&�'3 95 844-30% 44463 015895821 JJ <br /> 5, Generators Name and Mailing Address Generators Site Address (if different than mailing address) <br /> ARAM €•C k. NIFOMVI A€ D CAREER tAPI'AREL LLC <br /> 7679 LONGE ST <br /> STOCKTON, CA 95206 <br /> Generators Phone:209-234-01105 <br /> 6. Transporter 1 Company Name U.S. EPA ID Number <br /> PHI LIPW'vESTI € OLISTi?I.tALSERVICES <br /> 7.7ransporter 2 Company Name U.S, EPA ID Number <br /> B. Designated Facility Name and Site Address . U.S. EPA ID Number . <br /> CIiEfVI1Cv�,L 'J�tA�'TE �$1,�P1>aC�E€�9EI�I?" INC CAT00064 a 6117 <br /> 35251 OLD SKYLINE ROAD <br /> I'MLEKAS1, CA 03239 <br /> Facilites Phone: 900-222_246 <br /> go, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containersit. Total 12. Unit 13. Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantity wuVe. <br /> 1j g <br /> le NON RCRA HAZARDOUS WASTE, SOLID 1 C( d � � Y 4i±� C 44'1 _ 1�-�_ <br /> O <br /> w <br /> k <br /> Z Z. <br /> w t <br /> f <br /> 3. <br /> tl <br /> 4. <br /> 14. Special Handling Instructions and Additional Information <br /> PROFILE 4 CA008852 <br /> 15, GENERATOR!8OFFEROR'S CERTIFICATION: Ihereby declas that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> marked and Iabeledlplacarded, 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 <br /> Exporter, I codify that the contents of this consignment conform to the terms of the attached EPAAcknmvledgment of Consent. - <br /> 1 redity 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 quantity generator) is two. <br /> Gmwralos.siQkror, mile d/f - Signature Doth Day Year <br /> J 16. International Shipments <br /> [—. ❑ Impo to U.S. ❑ Export from U.S. Port ofentry/exiC <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> o= 17, TransporterAcknowiedgment of Receipt of Materials <br /> Transportrintedrryped Name Sig ore Moth D y Year <br /> a p <br /> QTr spa er dritedflypetiName Signaturejr dr Month Day Yea <br /> 18. Dls epancy <br /> 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility (or Generator) U.S. EPA ID Number <br /> :3 <br /> U <br /> Facilites Phone: <br /> w R7ignatureofAlternate Facility (or Generator) Month Day Year <br /> Q <br /> Q) <br /> Q) <br /> 19. Hazardous Waste Report Management Method Codes (1.e.3 codes for hazardous waste treatment, disposal,and recycling systems) <br /> 2. 3. 4. . <br /> 20. Designated Facility CAmr or Operator: Certification of r ipt of hazardous materials covered by the manifest except as noted ' em like <br /> PrintimiTyped Name Signature Mon D Year <br /> EPA Form 8700-22 (Rev. 3-05) Peviouseditions are obsolete. BEMMAEUFAUIgdsTOrESTgR3AT90MSTATE (IF REQUIRED) <br />