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wv � Fri ► ' •, � � �� <br /> Please print or type. (Form designed for use on elite (12-pitch) typewriter.) _ Farm Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1 . GeneratorlD Number 2. ge 1 of Pag3, Emergency Response Phone 4. Manifest Tracking Number <br /> WASTE MANIFEST MAEST CAL000406119r5 8 844-334-240x8 015895885 JJK. <br /> 5. Generator's Name and Mailing Address Generator's SlteAddfesS (Ndiferent than mailing address) <br /> A.RAMARK UNIFORM .AND CAPEER AP'PAPEL LLC <br /> 7079 LONGE ST <br /> STOCKTON, CR 95206 <br /> Generators Phone:209434-0105 <br /> 6, Transtiofferl Company Name U.S. EPA ID Number p6 <br /> PHILIP WEST INOUSIMAL SERVICES CAR000 . <br /> 7, Transporter 2 Company Name US. EPA ID Number <br /> 8, Designated Facility Name and Site Addressp U.S. EPA ID Number <br /> CHEMI CAL 'WASTE P��P,NI�G EMENT INC CATO0M..0117 <br /> 35251 OLD SKYLINE ROAD <br /> CCETTLEP�,M, Cry 93239 <br /> Facility's Phone: 801 -222-29(34 <br /> go. 96. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12, Unit 13. Waste Codes . <br /> HM and Packing Group (if any)) No. Type Quantity WUVOL <br /> AVON RCRtA HAZARDOUS. WASTE, SOLID 1 CIA , 1 ,3 491_ ,(� <br /> i <br /> w 3 <br /> f <br /> 3. ) <br /> 4. <br /> S <br /> 14. Special Handling Instructions and Additional Information <br /> PPOFILE20& CX1008852 <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable International and national governmental regulations. If expert shipment and I am the Primary <br /> Exporter, I codify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmentof Consent. <br /> I certify that the waste minimization statement identified in 40 CFR262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) Is We. <br /> Generator's/Off rots P ' ype fine Slgnat Month Day Year <br /> Ca �r d <br /> A 16, International Shipments <br /> i-- Import to U.S. ❑ Export from 0.8, Pod of entry/exit: <br /> z Transporter signature (for exports only): Date leaving U.S.: <br /> DZ 17. TransporterAcknowledgment of Receipt of Materials <br /> t2 Tmn der l Printed/fyped Na -= Signator Month yyDay Year <br /> O !o <br /> MR,eoe <br /> W <br /> Transporter Printed) yped Name Signature Month Day Year <br /> 18. Discrepancy <br /> 182. Discrepancy Indication Space ❑ quantity ❑ Type ❑ Residue ❑ Partial Rejection [I Full Rejection <br /> Manifest Reference Number: <br /> 18b. Alternate Facility (of Generator) U.S. EPA ID Number <br /> U <br /> czi Facility+s Phone: <br /> w 18c. SignatureofAitemate Facility (or Generator) - Month Day Year <br /> Z <br /> N19, Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 20. Designated Facility Owner or Operator: Codification of receipt of hazardous materials covered by the manifest except as noted In Item live <br /> Prkdod/fy ed Name Signal_ ore Month Day Year <br /> 14r— '9/lr�q 2� Ig <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACOUTY TO DESTINATION STATE (OF REQUIRED) <br />