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Please print or type. 111111111191111 Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page i of 3.Emergency Response Phone 4.Manliest Treftig Number <br /> WASTE MANIFEST 7 5 013120861 F L E <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> a r lieriE,ra', fli'L 3 5 9 '1)o:.J cZr G e-i E'i,a I It 1?r"."-32 <br /> 3112) W DR MAR-11M L!.lTl`IF-.R K;Nr JR <br /> .310 W DR WRI'TN 1..111'+{!=RKTINIG JR <br /> Generator's Phone: )f'10 N QEl 95206 1'763 STOCKTON. Cf.) 95206-17E,33. <br /> 6.Transporter I Company Name U.S.EPA(D Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 2eo0very S-Y�tems <br /> 8.Designated Facility Name and Site AddresSy,j Yj��- U.S.EPA ID Number <br /> nj:? jj_(" <br /> 'P730 F 13th Street <br /> °.1.78`, <br /> Facilil s PhoruP-.---*'f!;4-!='c1l938 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, 10.Containers 11.T.tW 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type ' Quantity WLA(bl. <br /> 111- L,-**!:4:t -7r---' m?7:9 P 371. <br /> r C,Cll.;' S 0 1 ;I I ( -' <br /> OC <br /> cc <br /> 1 <br /> Z i 2o n RC RA haziirdoi-ts oj�-iste, )Jquid (Conritimer 2 )F OQ1213 P 331 <br /> LU <br /> 3. <br /> 4. <br /> r4.Special Handling instructions and Additional Informawn 11 A 10529(Non-RCRA Solid Waste (CA On 10 - Lubsepack) 2 <br /> it! -'A.'ast e 01l'i Y) -- Laosiepa-"!() <br /> o 5 YC*g Ct <br /> 15. 43 EN ERATO A'S,10 FF EOOFZ'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classiffed,packaged, <br /> marked and labeled/plazarded,and are in all respects In proper cordiltion for transport according to applicable International and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EFAAdmvwWdWmyq Conwit A <br /> I certify that thewasteminimization statement Identified in 40 CFR 262.27(a)(if I am a large quantity garwriftr)0 Q(11 am a s44quanfity WS47ktrue. <br /> Gen slIXferor Name S uhf Month Day Year <br /> V4.%k IAO, 1*+1A-L,0 07 108 4019 <br /> ❑Import to U.S. DExportfrokU.S. T <br /> ow <br /> Port I/q.St: <br /> rspsignature(ler expoft ortly); Date I ving S.: <br /> ig 17.TransportarAclumledgment of Receipt of Materials <br /> LU <br /> Transporter I Pftedfryped Name Sign ure Month Day Year <br /> U) <br /> Transporter 2 Printed/Typed Name Signature Month Day Yew <br /> 1Aal-rI <br /> Nc-"e4z�L- 1 <br /> Z 10--,-1 rzl <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El Quantity EITYP. El R.1due El Partial Rejection 0 Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> FaciliVs Phone: <br /> uj 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> !a <br /> Z <br /> rn 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 <br /> LU 2.ult I -ML41 13. 14. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as rdgdV:n Item 188 <br /> KnWyped Name _ SignatureSignature Month 0 Y <br /> 11 Iril L4 B.1 - I <br /> U(A ( 1 +Ileai A- <br /> EPA Form 8700.22(Rev.f2-17) Previous editions are obsolete. DEW-GAA-U)FACILITY TO-EPA's e-MANIFEST SYSTr,,'!Vl <br />