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0 <br /> Please,print or type Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number2.Page 1 of 3.Emergency Response Phone 4.Ma 1fest Tr}ckiing Number <br /> WASTE MANIFEST Cwt ,�. -2134-16Ct 02�J 4 0 31�'-':J; JJ K <br /> 5.Generator's Name and Mailing Address Generator's Sfte Address(if different than mailing address) <br /> WILLMOP WES CO.LLC <br /> 1780 INDUSTA0.1.Dr. <br /> STOCKTON.Cly 95 <br /> Generator's Phone. r rt. r� <br /> 6 Transporter 1 Company Name U.S.EPA ID Number <br /> GeOrge W Lam,MO. <br /> 7.Transportar2 Company Name U.S.EPA ID Number <br /> 8 Designated Facility Name and Site Address U.S.EPA ID Number <br /> ISAtCt:ts'SMELD TRANSFER INC, <br /> 1620 e.1RUMAGE Ln CAL '.5 <br /> IYtK #SixI3,QP, 9M7 <br /> Facility's Phone: 61514224256 <br /> 9a. <br /> F51422- <br /> 9a. 9b U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Pacldng Group(if any)) No. Type Quantity Wt[V0I 13.Waste Codes <br /> 1, <br /> NONs L<.t 4 A t��f 1� �i�9d i SOLID (01t r <br /> 2. <br /> 0 <br /> 3. <br /> i <br /> 4. <br /> 14 Special Handling Instructions and Additional Information Nor t <br /> Aft MOVES <br /> 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 classi}ied,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemational 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 EPAAcknowledgment of Consent <br /> I certify 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. <br /> Gen erator'slOfferor's Printed/Typed Name Signature Month Day Year <br /> r <br /> r a <br /> .a 16 lhtemabonal shipments <br /> iElImport to U.S. ❑Export from U.S. Part of entrylexit- <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W f7 TranspoderAcknowledgmentofReceipt ofMatenals r <br /> QTrans r,1 P.� qd Name Signature Month Day Year <br /> x.': F..'� 4L <br /> CL <br /> Z Transporter 2 PriniedlTyped Name Signature Month Day Year <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑T <br /> 5'Re ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 18b.Altemaie Facility(or Generator) Manifest Reference Number: U.S.EPA ID Number <br /> .a <br /> CS <br /> LL <br /> Facility's Phone: _ <br /> ynj 18c.Signature of Alternate Facility for Generator} Month Day Year <br /> a <br /> a <br /> 19 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU G 1' 2. 3. <br /> 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PgntedfTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />