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Please print or type. Form Approved. OMB No, 2050-0039 UNIFORM HAZARDOUS 1. GeneratorlD Number 2. Page 1 of 3. Emergency Response Phone 4. ManifestTracking Number WASTE MANIFEST C A L 0 0 0 4 ® � J 1 �`3' 019515113 JJ K 5. Gepe�tgt ,g is ltn4Add[ess� .RVICES Generatofs Sile Address (if different than mailing address) 7a79 L E STREET S`I KTON CA Generatats Phone: 2 0 0 2 3 4 0 1 0 5 6. Transporter 1 Company Name U,S, EPA ID Number PHILIP WEST INDUSTRIAL SERVICES CAR 4 0 0 2 0 0 5 4 8 7. Transporter F2�Company NNaamde� Q ddf�g� U.S. EPA IO Number e. De-�gPp T� � WNH&�E .�YV ® ,sll r KETTLEMAN HILLS � U.S, EPA ID Number ''.,,,........ 35251 OLD RGAD KETTLEMAN CITY CA 93239 CAT 0 00 6 4 6 1 1 Facility's Phone: `x-9711 go. 9b. U,S. DOT Description (induding Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity Wuvol. 1. MON RCRA HAZARDOLIS ASTE: SOLID - (y 491 0 0 1 CM GD046P Y W C7 3. 4. 14- spacAaUia,,old ns �n��r �%110naJ.6a9VMBER 122-1510-0010—J0001 �'}Z.UG � � y �7 3 7 Xbrgq jam 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully abd accurately described above 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 Imornaflonaland national governmental regulations. It export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknoMedgment of Consent. I codify that the waste minimization statement Identified in 40 CFR 262.27(a) (If I am a large quantity generator) or (b) (ifI am a small quantity generator) is true, GeneratatslOK ro�s&rin Ryp ' Signator _ Month Daayy Year ® & egg ® V r 16. International Shipments El Import to U.S. ❑ Expod from U.S. Port of enlrylexit: F � Transporter signature (far exports only): Date leaving U.S.: W 17. TransporterAcknovdedgment of Receipt of Materials Trans of di er1 PnmedlTyped Name Signature K Month Day Year o e Transporter Pdntedtlyped Name Signature Month Day Year h 18. Discrepancy 18a. Discrepancy Indication Space ❑ quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number '.. J U Facility's Phone: 18c. Signature ofNternate Fac!lily (of Generator) - Month Day Year Q z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment. disposal, and recycling systems) 2 3� 4 1 "'. 20. Designated Facility. Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a Prime typed Name Signature /7 /') Month Day - Year EPA Form 8700-22 (Rev, 12-17) Previous editions are obsolete. - DESIGNATED FACILITY TO EPNes eaMANIFEST SYSTEM '',