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Please print or type. Form Approved.OMB No.2050-0039 1Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manliest Tracking Number UNIFORM HAZARDOUS . CA D 9 8 2 3 5 6 9 4 1 1 t500i 424-9300 ''' WASTE MANIFEST :- �+�L 0 '; J J K 5.Gena, d mg Address Generator's Site Address(if different than mailing address) "ems"19 ; 2373 E. MAIR IPQSH RV. STOW' ON CA 95205 2=373 E MARIPOSA ROAD Generators Phone: 209 464-7635 STOCKTON CA 95215 6 TranU.S.EPAR81MW E 2 7 7 0 3 6 IRONMEN T L SERVICES 7.Transvarter 2C. U.S.EPA ID Number 'Tv[Ne kGOVERY SYSTEM INC. CAR 0 0 01 7 5 4 2 2 8.Designated F-aciliri.Name M MAdd e,�s U.S.EPA lD Number YE5 MAfiSAL-:=M�IV1. 6500 LIS HIGHWAY 95 YLI IvMA.. 15385 A-L R 0 O 0 5 2 11.4 6 Facili 's Phone: (928344-9(328 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group('d any)) No. Type Quantity Wt.Nol. 1. NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLIDS) DIM j P z 2- w c7 3 4. 14.Special liandl'mg Instructions and Additional Information E lVlERGEN:;','CONTACT:CHEAMTREC 1-60-424-9300 WOES TERMINAL:CERES CS' NAERG#931:173 P%F!LE W 98J. 1.6262,3NRSMAX602 OILY SOLIDS APPROPMATE PPE EQUIPMENT f; -7 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,and are classified,packaged, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(fI am a small quantity generator)is true. Generato s+Offeror'=Printed/Typed Name Signature __ MMononth flay Year 16.International Shlpments F ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S W 17 Transporter Acknowledgment of Receipt of Materials LU Tra1 PnnladlTyped Name Signature Month Day Year 1 a Z n �I /1 r, rf -)gz Transporter 2 Nnted7ypad Name, Signature ] Mor Day Year c-O n� 18.Discrepancy r 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑aesldrre ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Gene=rt U.S EPA ID Number nai FarHlly�i Phone: H18c.Signature of Alternate Facility(or Generator) Month Day Year Q z H19.Hazardous Waste Report M3,aa•,men:Method Codes(i.e.,codes for hazardous waste treatment,disvosal.and recycling systems) 0 1. 3. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Prl atInto. Signature Mdnlh DayYear EPA Form 8700-22(Rev.12-17) Ptpviaus editions are obsolete. DESIGNATED FACILITYTO GENERATOR