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Please print or type. Form Approved. OMB No, 2050-0039 <br /> UNIFORM HAZARDOUS 1. Generator ID Number 2. Page lot 3. Emergenc Response Phone 4. Manifest Tracking Number ry� <br /> WASTE MANIFEST C A L 0 0 0 4 ® 5 5 9 42 019515114 <br /> 5. Ge �nd M i' Generators Site Address (if different than mailing address) <br /> 7979 LONGE STREET - <br /> STOCKTON CA 95206 <br /> Generators <br /> rj Phone:m 209 2 3 4 " 0 1 0 5 <br /> 6, T <br /> MUS IAL SERVICES U.S. PA Rm0` 0 0 2 6 9 5 4 8 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 8. Deftled Eaci WA5 T i INC• KETTLEMAN HILLS U.S. EPA ID Number <br /> 30231 OLD SKYLINE ROAD <br /> KET TLEWN CITY CA 93239 <br /> FacilllYs Phone; 3NW 9711 <br /> ga 91h. U.S. DOT Description (including PmperShipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes '.. <br /> HM and Packing Group (If any)) No. Type Quantity Wt.Nol. <br /> 1. WN RCRA H47AR $ $TET $0LID 491 <br /> 00 1 CM W015 y <br /> nS <br /> W <br /> 0 <br /> 3. <br /> 4. <br /> ,4. 6ab �ne�� �"� °"�13� �199fr�� 122— .1510— O0 O— LT0001 &OW <br /> JOEW <br /> 15. GENERATOWSIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accuratelydescribed 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 internatlonaland national governmental regulations. fexport shipment and l am the Primary '.. <br /> Exporter, I comfy that the contents of this consignment conform to the terms of Ne attached EPAAcknoviledgmenlof Consent. <br /> I cerfify that the waste minimization statement identified in 40 CFR 262.27(a) Qt I am a large quart itygenerator) or (b) (if] am a small quantity generator) is We. <br /> Gemeratorsl0fferors Printedfryped Name Signature Month Day Year <br /> ~9AAJ1< 11rN4 I �� f <br /> 16. international Shipments Import to U.S. <br /> ❑ Export from U.S. Port of entry/exit; <br /> z <br /> Transporter signature (for experts only): Date leaving U.S.: <br /> w 17. TrensporterAcknowledgment of Receipt of Materials <br /> mnspo 1PrintedRyped Name Signator Month Day Year <br /> & 2 <P <br /> 00 Transinmyr2lFrintedi NameSlgnafure Month Day Year <br /> r- <br /> r18. Discmpancy <br /> 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Padlai Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> iBb. Alternate Facility (or Generator) - U.S. EPA ID Number <br /> J <br /> U <br /> r+a. Facility's Phone: <br /> 18c. Signature ofAltemate Facility (or Generator) - Month Day Year { <br /> Q <br /> 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 0 1. 2. 3. _ 4. <br /> 32 <br /> 20. Designated Facility Owner or Operator: Cer88cation of receipt of haz ous materials covered by the manifest except as nded in Item 18a - <br /> PdntedlTypedName Signature Month Day Year <br /> EPA Form 8700-22 (Rev. 12-17) Previous ed ' ns are obsolete, _ DESK _ '- 'FACILITY TO EPA's &MANIFEST SYSTEM <br />