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Please print or type.(Form designed for use on elite(12-pitch)typewriter.)
<br /> 1.Generator ID Number Mimi.
<br /> Form Approved.OMB No.2050-0039
<br /> UNIFORM HAZARDOUS 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number C
<br /> WASTE MANIFEST AL000379S0S 11 �j`2 2 (�L E
<br /> 5.Generator's Name and Mailing Address '=��
<br /> Generators Site Address(f different than mailing address)
<br /> S a.r t .& Final #407: Swart 8 Fina 3#4&;
<br /> 209464 629
<br /> 1.47..N .Wilsan,gWa ,47 N_ Wilson Way
<br /> Generators Phone: 5.tockt.on. .GA ::.. .. 95205
<br /> 6.1 ransponer t Company Name -Stockton. CA 95-,'05
<br /> ti
<br /> U.S.EPA ID Number
<br /> StericYCl a Soeciaity, W sts Solutions Inc... MI+1 0td0)3t�9;=4
<br /> 7.Tran '"
<br /> " " ompany Name
<br /> �s U-S'.EPA ID Number
<br /> 8.Designated Facility Name and Site Address V V
<br /> Rho, Che If. .,C.L..0 U.S.EPA ID Number
<br /> N
<br /> 425 IsisAvenue , h
<br /> In,alewaodt
<br /> Facili s Phone: ,
<br /> �. 3c377fi623�
<br /> 44
<br /> 9b.U.S.DOT Description(including Proper Shipping Name,HazardDass,lb Number
<br /> 9a. 10.Containers.
<br /> 32,
<br /> HM and Packing Group(if any)) 11.Total 12.Unit
<br /> 13.Waste Codes
<br /> No Type Quantity WLNbl.
<br /> 1�� Wagt.e Corrcrs:i��+,•l�u�i-�6 +~�
<br /> inaraanic, n. o. a. (5adiue.H��.droxide. Sad.irra S,. . .1,22 DIM; ,
<br /> ; .
<br /> t„ -:� :�v,00chlar^,ite.).. ;&.c,PGf l:,t,�•,.� 154 3 ...�;:
<br /> Uj, ;ton. RCRA hazardous waste., s.oli.d ,(Con,�udier 1 CF
<br /> Products). 00036 P 331
<br /> ion ,RGRAsha;ardous waste.,,l,inu d _(Cacrsulter . 1
<br /> ,Products). IIF. ,; 0195
<br /> a. a
<br /> 14 Special Handling Instructions and Additional lnforma;;o "
<br /> 1. 1125) (CorrQ,sive:,8ats,ic J-iau (State Reaulatett
<br /> e- .ReRu ted Liquids,
<br /> 13. GENERATOR'S/fFFEROR'S-CEIt1FICATIINV: Itrefebydedare ltatihegaiilentseftOis p
<br /> marked and labeledtoacarded,and are in all respects in 'f oment are�tiy--and awtrratelyd fitted a e by the proper shipping name;and are classified,pacicaged,
<br /> pNper condfian fior'tr pod et f# 104 Ne fntimattorraf andeatiorlal •;"tr}ntentgl ' Mations.If ex rt shi ti
<br /> Exporter,I cerlity that the contents of this consgn t conform"to"the terms of�the ahetlAA1edg export pment.and t am the Primary
<br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a fa © nsenL
<br /> s/ erors Pnht Yped' arid" 4�m1 > ) l am a emal no ,prator)is true.
<br /> wOmay oar
<br /> j 16.International Shipments
<br /> ❑import to U.S. Export from US, part of
<br /> Transporter signature fore its onl
<br /> 17.Trams Date
<br /> tL porter Acknowledgment of Receipt of Materials
<br /> F Transporter 1 Printed)IYPed Name
<br /> CD
<br /> i tti. t
<br /> CL W thonv Mack Month
<br /> ZTrans rinted/Typed Name
<br /> l G' on #y YAW
<br /> 18.Discrepancy (
<br /> 18a.Discrepancy Indication Space
<br /> Quantity ❑Type
<br /> Residue Q Partial Rejection Full Re'
<br /> lection
<br /> 18b.Alternate Facility(or Generator) Manifest Reference Number,_,
<br /> U.S.EPA ID Number
<br /> a
<br /> ;'- Facili s Phone: f
<br /> 1Uj ttic.Signature of Ntemate Facility(or Generator)
<br /> ZMonth Day Year
<br /> CD
<br /> 19.Hazardou Ste Report Management Method Codes(i_e,codes for h s waste treatment,disposal,antl i
<br /> ms)
<br /> 3: 4
<br /> 20.Designated a c r or Operator:Cerdcation of recei t of hazardous materials covered 61 the mann
<br /> ;
<br /> Printed/rype ame rN Item 18a
<br /> 7 _ _
<br /> Jonth p ly
<br /> EPA Form 8700 ev.3-05) Previous editions are obsolete.
<br /> 3 �S
<br /> DESIGNATED'fA,ILITY70>DESTINATION STATE;OF REQLqRM
<br /> V 6700-22 12u'i I^otoraenn„
<br />
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