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793581 <br />Oil <br />S�� ( Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) �FLD15u ' U <br />U I J•"• GVL7_ - <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete.r, z • n 0 I N DESIGNATED F4 1LITY TO GENERATOR STATE (IF REQUIRED) <br />07-10-07 10221.1542 ��lJ <br />UNIFORM HAZARDOUS <br />i. Generator IDN 'e..�000143776 <br />2. Page 1 of <br />z <br />3 Emerge <br />`°!'��7-745 <br />.Manifest Tracking Number <br />001952716 JJ K <br />WASTE MANIFEST <br />5. Gt(Mtr`CKM Mailing Address GM?et"rens If different ifwn mailing address) <br />316 N. RAIn STREE4 316 R. RAID SfflBET <br />LODI CA 95246 (289)368-4691 LODI CA 95240 (209)368-4691 <br />Generator's Phone: •. <br />6. Transporter 1 Com--po �Na U.S.. EPA ID Number <br />St c�IitxY <br />21``me-- 1:}Q 2 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8. Designated Facility Name and Site Address US EPA 10 Number <br />21st Century BRI <br />2995 Realands Or. bast <br />Fernley, DV 89498 (775) 575-2766 NVM80895338 <br />Facility's Phone: <br />ga <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12, Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />yyWcl <br />1 WASTE CORROSIVE LIQUID, ACIDIC, INORGANIC, R.O.S. (SULPDRIC ACII, <br />BIG <br />UVIIIII, <br />o <br />R <br />LEAD) 8 093264 PGII 20602) <br />1 <br />IJV <br />S <br />G <br />9 <br />792 <br />LU <br />Z <br />2 <br />LU <br />C7 <br />3, <br />4. <br />14. Special Handling Instructions and Additional Information <br />(1) 11612SA-86 - ERG(154) RICIZL STRIP SLUDGE <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment aro fully and accurately described above by the proper shipping name, and are classifled, packaged, <br />marked and labeledlplacarded, and are in all respects In proper condition for transport according to appl:cab!e Intemabonai and national governmental regulations. If export shipment and I am the Primary <br />Exporter, I certify that to contents of this consignment conform to the terns of the attached EPAAcknowedgmert of Consent. <br />I certify Nat the waste minlmlzetlon statement idents l in 40 CFR 282.27(,) '11 am a large quarttdy generator) or (b) (i1 I em a ,,It Guan5ty generator) ls true. <br />Ge tor'sJOfferor' Printed/Typed Name SI Month Day Year <br />�� 2' /,9 107 <br />-J <br />18. Intematr6rra6hIpMents ❑ Import to U.S. ❑ Export from J.S. Port of entry/exit <br />Transporter signature (for exports only) Date leaving U.S.: <br />17. Transporter Acknowledgment of Receipt of Materials <br />Trer porter 1 PhntedfTyped NameS gra Month Day Year <br />a <br />/) <br />7/ 1 U /o 107 <br />r„ <br />c� i <br />Z <br />Transporter Z PrintocirTyped Name Signature Month Day Year <br />CC <br />H <br />18. Discrepancy <br />I 8a. Discrepancy Indication Space <br />Quantity ❑Type 11 Residue Partial Rejection Full Rejection <br />Manifest Reference Number <br />18b. Altemate Fac5ty (or Generator) U.S. EPA 10 Number <br />J <br />U <br />LL <br />Facility's Phone: <br />W <br />18c. Signature of Alternate Facility (or Generator) <br />Month Day Year <br />a <br />z <br />rn <br />19. Hazardous Waste Report Management Method Codes (.e., codes for hazardous waste treaonent, disposal, and recycling systems) <br />c LU <br />1 / r / <br />2 <br />1 <br />3. <br />4. <br />Designated FadGry Own/Ver or Operator. Cert flcation of receipt of hazardous mate els covered by the manifest except ars paled in Item i as <br />1Zo. <br />1 <br />Pr nted(Typed Name <br />eZLam <br />Signature Mon Day Year <br />bar%/Y-Yu�t � o� -/o 16 <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete.r, z • n 0 I N DESIGNATED F4 1LITY TO GENERATOR STATE (IF REQUIRED) <br />07-10-07 10221.1542 ��lJ <br />