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Please print or type. Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergenc Response Phone 4. Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 4 . 0 5 5 0. 5 1 '�'24W 019515104 JJIf 5. Gerlaretor's Narpg,and Maiin¢AddressSEIRVICES Generators SiMAadress (if different than mailing address) 7579 LONGE STREET STOCKTON CA 95206 Generators Phone: 209 2 3 4 - 0 1 0 5 6. Trapp,, ��Company�TamtN ®U.�iTRIAL SERVICES U.S. EPA ID Number CARO 0 0 2 6 0 5 4 8 7. Transporter 2 Company Name U.S. EPA ID Number It. Desionatetl.Eaclgly N9 eagd.Si(e9ft8INC- KET LEMAN HILLS U.S. EPA ID Number 35251 OLD SKYLINE ROAD KETTLEMAN CITY CA 93239 Facility's Phone: 559 386. 9711 C A T 0 0 0 6 4 6 1 1 7 9a, 9b. US. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 1(I. Containers 11. Total 12. Unit HM and Packing Group (If any)) No. Type Quantify Wl.NoL 13. Waste Codes a, 1. NON RCRA HAZARDOUS WASTE, SOLID , O 0 0 1 CM 00015 Y w z z w c7 3. 4. 14. SFI20FSI, 'InslCuAo�n�a�d�da�mn�8t�ma�� 122 - 1510- 0010—J[Iffl JOB 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, am are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable li fernatlonaland national governmental regulators. 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 or Consent. I certify that the waste minimization statement I tied in 0 R 262.27(x) (if I am a large quantity generator)or (b) (if I am a small quan 'ty ga eralor))Shue. Generaforsl0fferor's Pdntedffyped . me T Signature Month Day Year Ill. International ShlpfrorlW 1 F- l Import to U.S. ❑ Export from U.S. Pod of entry/exit: ? Transporter signature (for exports only): Date leaving U.S.: W 17. TrensporterAcknowledgment of Recelpt of Materials ad oTransporter 1 PrintediTyped Name Signature Me Day Y a i a , .5 7 . i / zQ Transporter2 Pdnteallyped Name g ura K Month Day Year F- Till. Discrepancy fire. Discrepancy indication Spam Quantity ❑ ❑ Partial Rejection Type Residue I ❑ Full Rejection r}- 18b. Alternate Facility (or Generator) Manifest Reference Number: J U.S. EPA ID Number U rra. Faciity's Phone: Lo i6c, Signature ofAlternafe Facility (or Generalar) Q - Month Day Year Z y19. Hazardous Wase Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) ad 1' 2, 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as nded in item Ise —Part arty artypbd Name Signature 1 Month Day Year L bar 7 EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e4ANIFEST SYSTEM-