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Please printor type. Form Approved, OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1 . Generator ID Number2. Page 1 of 3, Emergeenc Response Phone 4. Manifest Tracking Number p� <br /> WASTE MANIFEST C A L 0 0 0 4 0 5 5 9 5 1 84=24135 019515102 JJ 1® <br /> 5. 'OXA ots NarpaI Maiinn.Addr SEHV(CES Generators SiteAddress (If different than mailing address) <br /> 7679 LONGE STREET <br /> SSTOCKTON CA 95206 <br /> Generators Phone: 2 0 9 2 34 0 1 0 5 - <br /> 6. TraPLIP INDUSTRIAL SERVICES usCEP�D NNamb0ar 0 0 2 6 9 5 4 0 <br /> 7. Transpodm-2 Company Name U.S. EPA ID Number <br /> B. DoM9FariilluN 4A6Site&d T,8ING- KETTLEMAN HILLS U.S. EPA ID Number <br /> 35251 OLD SKYLINE ROAD <br /> KETTLEMAN CITY CA 93239 <br /> Facility's Phone; <br /> 559 386. 9711 C A T 0 0 0 6 4 6 1 1 7 <br /> Saw 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 Oak)) No. Type Quantity WL17ol. <br /> 1, NUN RCRA20 . 481 <br /> 0 <br /> 0 0 1 CM - Y <br /> z <br /> Z. <br /> 0 <br /> c� <br /> 3. <br /> 4, <br /> 122 - 1510- 0010- J0001 <br /> JDB# <br /> 15. GENERATOWSIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, ard 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 export shipment and I am the Primary <br /> Exporter, I cergfy that the contents of this consignment conform to The terms of the attached EPAAcknowledgment of Consent , <br /> I certifythal the waste minimizalion tatemen identified in 40 CFR 262.27(a) (if l am a large quantity generator) or (b) (IN am a small quantity generator) Is We. - <br /> GeneratorslOfferors led/ryp a e Signature Month Day d' <br /> � ' <br /> 16. International 91blipments dto ,S. <br /> P , ❑ Ire Po ❑ Export from U.S. Part ofentrylexit: <br /> z Transporter signature (for exports only): Date leaving U.S.: <br /> W 17. TranminterAcknowledgment of Receipt of Materials <br /> Tmnspo IPrinte yed Name Signator '* Month Day Year <br /> 0 <br /> o- W 4J <br /> aTranspode 2 Prmtadfiyp-eg Name Signature V Month Day Year <br /> r—' <br /> 18. Discrepancy <br /> Ito. Discrepancy Indication Space ❑ Quantity ❑Typ ❑ Resldue <br /> ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> I8b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> J <br /> U <br /> < Facility's Phone: <br /> w 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> Q <br /> z <br /> N19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste Treatment, disposal, and recycling systems) <br /> R 2 2 3. 4. <br /> 20. Designated Facility Owner oralar. Certification of receipt of hazard material covered by the manifest except as noted in Item Ilm <br /> Printed/typed Name Signature kponjh Day Year <br /> EPA Form 8700-22 (Rev. 12-17) Previous editioM are obsolete. ®ESICNATE ILITY T® EPA's e•MANIEEST SYSTEM <br />