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Please print or type. + Form Approved. OMB No. 2050-0039 <br /> 1. Generator ID Number 2, Page 1 of 3, Emergency Response Phone 4. Manifest Tracking Number - <br /> U IFORMWASTE MANIFESTOS C A L 0 0 0 4 0 5 5 0 5 1 ® 19 5151 � 5 �� <br /> WASTE MANIFEST <br /> 5. GaXflafots 1rf iglNg,®d4fg;s � �� Generatots Site Address (Ifdifferoibnmaiimgaddress) <br /> 7579 LONGE STREET <br /> STOCKTON CA 95205 <br /> Generatots Phone: 2 0 0 2 3 4 - 0 1 0 6 <br /> US EPAID Number <br /> 6. Transporter i Company Name AI Nu bO ® 4 <br /> PHILIP ST INDUSTRIAL SERVICES <br /> 7. Transporter2 Company Name U.S. EPA ID Number '.. <br /> 8. De�si,g�n�oted Fadll�iftyy INy me and Siteggddress U.S. EPA ID Number <br /> 1(t�IS7� UNAGEMENT, INC- KETTLEMM HILLS <br /> 35251 OLD SKYLINE ROAD <br /> KIETTLEMAN CITY CA 33239 CAT 6 0 0 4 0 1 1 <br /> Facility's Phone: 50 -011 <br /> ga. 9b. 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 Ouaniity WWoI. <br /> x <br /> t NON RCRA RI0US STE. SOLID 401 <br /> 00 1 CRR W015 y <br /> w <br /> c� <br /> 3. <br /> 4. <br /> 14. 1cial Handlln Instructions and Additional lnformagbn `� 1.,1Li- 0010- 7000 <br /> YROPHE CA608852 SOB NUMBER 1 ' 2— F <br /> ® �' _ <br /> 15. GENERATOR'SIOFFEROR'SOERTIFICAT : thereby declare that the contents or thus consignment are fully and accurately described above bylhe pus ershipping name, ment a and are classified,he packaged, <br /> marked and labeled/placarded, and are in all respects In propercondilon for banspod according to applicable intemagonaland national governmental on ulagons. It export shipment and am the Primary <br /> Exporter, I cuddly that the contents of this consignment conform to the terms of the attached EFAAcknowledgment of Consent. <br /> I certify that the waste minimization statement idenlified_ in 40 CFR 26227(a) (H l am a large quantity genelator) or (b) (if I am a small quantity generator) is We. Month Day Ye r <br /> GenerdtORer is Printed,�j/p� Na,� t( Signature <br /> l/( d d <br /> J 16. Internationa Shipments <br /> F ❑ Import U.S. ❑ Export from us. Pod of entrytexit: <br /> Transportersigr a ure (for exports only): Date leaving U.S.: <br /> W 17. TranspotlerAcknovdedgment ofReceiptof Materials Month Day Year <br /> L2 T spoder 1 Pdntedflyped Name Signature L , <br /> O <br /> ir. Month Day Year <br /> Transporter 2 Printed/Typed Name Signature <br /> t- <br /> 18, Discrepancy <br /> 18a. Discrepancy Indication Space Guamity ❑ Type ❑ Residue Full Re' <br /> ❑ partial Rejection lection <br /> } Manifest Reference Number: U.S. EPAIDNuinbar <br /> r 18b. Atoomate Facility (or Generator) <br /> J <br /> U <br /> < Facility's Phone: Month - Day Year <br /> w 18c. Signature ofAltemate Facilily(or Generator) <br /> Q <br /> z <br /> 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> ® 1. 2. 3. 4. <br /> US 77777 + <br /> 20. Designated Facility Owner or Operator: Certification of receipt of ha Nous materials covered by the manifest except as need in Item 1 Month Day Year <br /> PrintedfFyped Name Signature . <br /> EPA Form 8700-22 (Rev. 12-17) rev s tions are obsolete. ®ASICs E® FACILITY TO FDA's O=M NIF6ST SYST M <br /> A' a • �. _ K) -9 • . -90 ,_ . . 13'72 <br />