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"SK'SI•I I Pff eF 73 O2 4n r"orm designed for use on elite(12-pitch)typewriter.) r; Form Approved.OMB No.2050 0039 1.Generator ID Number 2,pa ,+ZARDOUS � � �, ge 1 of 3: me Res se Ph 4.Manifest Trackin Number. �gp MANIFEST .'#fra87 $ �i f -010 FLE or s Name and Mailing Address Generator's Site Address(if different than mailing address) JESA -� Goldec Gats AU SI a ..Iden Sate A591 West Stanford Rd Att,n S mtael Mchenry 18501 Stanford Ind TRACY CA 55377 Atth LesteO Sabo jenerator'sPhone: pip 2R9, #-g 374 TRACY CA 9 ; 3'77•-9708 6.Tr A9fV.TR y eJ ySTE 2 INC U.S:EPA ID Number Z-Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address ` " U3.EPA1D'Number Ty"'I'�LEE CALIFQ'RNIA 688SMITH AVE. NEWARK � � CA 9456.0 Facility's Phone: CAM0887418 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No, Type Quantity WtNoi, 1. N —RC'RA 14AZARDUIJS WASTE9 LIQUID IT0 MED OIL) S + 1 z 2: W 3. Y, 4, 14.Special Handling Instructions and Additional Information _ - - - t' 24 HR EMEROENCY 1"fit --4 ;- 17 @ (Cts A SK ® TFI) y RUTH S "AGENT—FOR" BY 3 TO RETAIN TeX ,.:FUSED �SUR CARRIERS AS NECESSARY PTtl.� u 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby/declare that the contents:of this consignment are fully and accurately described above by the proper shippjog 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 regoations.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)o (b),(tf I am a small quantity generator)is true. Genera is Offeror's Pdntedlryped Name igna ure JMonth Day Year. --1 16.International Shipments Z Import to U.S. F]Export from U.S. Port of entry/exit.• Transporter signature for exports only): Date leaving U.S::. w17.Transporter Acknowledgment of Receipt of Materials g Tra porter 1 Printed/Typed a € �> ignaMonth ay Year �t. L � -;� 4 -Z 129 1 Transporter rintedlTyped Name 41 Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type F-1 Residue Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S:EPA ID Number a- V W Facility's Phone: H18c.Signature of Alternate Facility(or Generator) Month Day Year Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems), LU 1 2. 3. 4. : j P 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifestzezcept as noted inrItem 18a PrintedfTyped Name Si n lure Month Day. Year r EPA Form 8700-22 Rev.3=05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR 1) 11 4� 5G@I