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Please print or type, (Form designed for use on elite (12-pitch) typewriter.) - Form Approved. OMB No. 2050-0039 UNIFORMHAZAROOUS 1. Generator ID Number 2. Pagel of 3. Emergency Response Phone 4. Manifest TrackingNumber WASTE MANIFEST C A L 0 0 ❑ 4 §3 � � i. � - � ( $1-f�) 4 '3� _ CA3t.)tl 01118628 JJK 5. Generator's Name and Meiling Address GeneMtara SlfeAddress tit amerem than marling address) ARAEI 7679 S. LONGE ST. STOCKTON CA @MOB Generators Phone: ( 2 01) 234 84 L16 6. Transporter l Company Name - U.S. EPAID Number 7. Transpoder2 Company Name GS, EPA ID Number 8. Designated Facility Name and SImAddress U,S, EPA IO Number CHEINACAL VAST EMAiIA ENIENT, INC. 3528.1 OLD SKYLINE ROAD r A 8 G 0 6 4 8 1 1 7 KE'1 fLEI CITY CA 03339 _ Facility's Phone: (. 5594) 386' 9711 ga. 9b. U.S. DOT. Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Cents' am 11. Total 12, Unit HM and Packing Group (if any)) - No. Type Quantity Wt.NOI. 13. Waste Codes 1. NON RCRA HAZARDOUS 'ASTE SOLi0 491 0138852 0 CVAJ f Wz 2, 3. 9 14. Special HandlingInstructions and Additional Information 9 , CA01. 88-52 e � 15. GENERATOR'SIOFFEROWS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described abve by the proper shipping name, and are classified, packaged, marked and labeled/placarded, 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 terms of the attached EPAAcknowledgment of Consent. I county that thewasteminimization statement Iden tied in 40 CFRz62.27(a) If I am a large quantity generator) or (b) (ID am a small quantity generator) Is fast. l08ero Genemtoes61culfTyped a Signature – Month Day Year ��-- 16. International Shipments "r ❑ Importto U.S. ❑ Expertfmm U.S. Port ofentrylexil: z Transporter signature (for exports only): Date leaving U.S.: W 17. TransporterAcknowledgmentofReceipt ofMaterials ' E2 Transporter l Pdnledflyped NameSignature / � — Month Day Year 0 11 a GTransporter Printout Iyped Nitrate ig lure Month Day Year K a— 18. Discrepancy Inc. Discrepancy Indication Space ❑ quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Refection Manifest Reference Number: 186. Automate Fa fli ity (or Generator) U.S. EPA ID Number J U ua– Facility's Phone: 18c. Signature of Alternate Facility (or Generator) Month Day Year H z in. Hazardous Waste Report Management Method Codes III codes for hazardous waste treatment, disposal,and recycling systems) 1. 2. 3. 4. _ 20. Designated Facility 0 er or Operator. Certification of mcei of hazardous materials covered by the manifestexcept as noted in Item 18a Printedffyped Name Signature Mo Day Y EPA Form 87OO-22 (Re . - ) PreviI eitionsare obsotete. EESaMATE® 7C@L6TY E8TINATIONSTATE (IF REQUORE®)