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811 Zephyr St, Stockton, CA 95206 Record ID# PR0539941 <br /> Date of Inspection 09/12/2018 <br /> PHOTO 17: Manifest has no waste codes or disposal quantity listed <br /> r <br /> Form Approved.OMB No,2050-0039 <br /> 2.Peg'I of 7.Emergency Response PM1une a.Manifest Tzs'Niny Number 8 FILE <br /> Plga�pM1nl br IyDe 012328 9 0 <br /> TGerAralor lDNumcer re 1$�•�i�h.It <br /> } <br /> UNIFORM" 1 ,ene o <br /> I WASTEMAMFP.ET C/1L.000`M77015 raseAaaress ranerem hanmarlm ad lI <br /> r— mtlaea�a R9mevledBY•� <br /> he <br /> ( , PA D N mbar GAR9dW705sKi <br /> �. � T �.4 dlemiral 7TN„iped hc•IDBA AGTEM71R0 lus.EPA ID Nember <br /> ' S rxANrlf F US EPA ID Number <br /> e oerg nee F;ei�6 Nama ane sae naamea ,y�pb%1515ff14 <br /> h - 1p.Contairers II.Total 12.Unit 13.`Nas@ fAdes <br /> Tpe �p ion(mclea ng pe M1ppng Name,Nazard Llass,ID Number. Tyra Ouannty WI NoI. <br /> arM PxYm Grou danY)1 Pro r5 30 <br /> M'NuaRCItA'llawrdons Waslc.Soid,lOdy Solids) OM ,�1 P <br /> G, <br /> 'NOn-RCRA Ilazudons Weutc ligand 0dcx PbUmm Carrs) 1136j <br /> `/V0" &)�'ZOAZA a MUST',t ru.,6co <br /> IALXri�urt Ak D s ---- <br /> ,.SpxrarNandnP nevucronsaaAdd tuna <br /> Pro)e.x M-16.1671416 [ac 441 r <br /> 3) t ssamY pE'"�� <br /> X 6'dr t <br /> Lr 42N QXd be,by <br /> pb, pp,f LJ d cT <br /> 15.maENERATORS/O11e SCERare In TION In by tleclare M1al the wntenR of th's consgnmenl are lollyantl accuralel Oescdbetl above by lM1e proper sb' <br /> ked and lahekNpl tlea d pet p per mntll onfortmneporl acrgN ng to apPl wble'nlemalronaldntlynalonal govemmenlal regulations.Pl expod saDmentranal am NeP ma�iy� <br /> II ce�fy Ihal Ne w sletm'ri m zal'on sUtemenl 11140 CFR 262 2](a1(ifhamtla arleEPAAchnowletlgment of Consent. <br /> GaneralorslDMemlS pnnletl/Typetl Name 9 quantify generator)or(b1(Iflamasmall quantify generalorl is We. <br /> I`,lf[i A 4 CJ Sgnalure e, Day year <br /> r I6.International Shipments --1/ G—,C, <br /> Z ❑Import to U.S. <br /> ❑Exon fm U S <br /> ro . <br /> iranspodersignalure llor exponsony): P Forl of enVylexi1 <br /> ¢11.TransponerAcknox9etlgmenl of Receipt o(Materials Date leaving U.S.: <br /> Transporter I Print'/Typed Name <br /> Nb Signat e Month DaV year <br /> 1S/porter2Pdn ypMry Fl.r�� I <br /> ' <br /> �i 1\ 1'T`�� Llonth Day Year <br /> I Ida.Ors-porn kation space <br /> ❑Ouamiry ❑Type ❑Residue <br /> ❑Partial Rejection ❑f II Rejection <br /> J161,.Allernele FacNty(or Generator) Manifest Reference Number: <br /> U U.S.EPA ID Number <br /> Q Fariliys Phone: <br /> 18a Signature of Allemale Fa gnly(or Generator) <br /> V, Month pay Year <br /> N 119.Hazardous Waste Report Management Methoe CMII,.e..Mees ler hazardous waste lrealmelll,disposal,and acyding systems) <br /> 1 1 2.2011 gnat''Fac lity Ovmer or Operator Certification of receipt ofhazardo mate ars overed by the man fest except as ntl!n <br /> on el I8a ��5, <br /> m pee am' <br /> G9natur� -� <br /> lT n2 , Mo th ey hear <br /> _ EPA Form 8700-22(Rev.12-17)Previou itions are obsolete. <br /> DESIG ATED FACILITYTO GENERATOR <br /> Tricia Dai, EHS Page 17 of 24 <br />