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Please print or type. Form Approved.OMB No.2050-0039
<br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.hUfg�t Tgckdng�umger-,
<br /> WASTE MANIFEST r1 1V11>�e� ' —r 3 35 F L E
<br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address)
<br /> Alsin t:lBC nDnIrA Ie'lP,±
<br /> 198 Fr"V*St
<br /> Stockton, CA 9
<br /> Generators Phone:
<br /> 6.Transporter 1 Company Name U.S.EPA ID Number
<br /> 7.Transporter 2 Company Name U.S.EPA ID Number
<br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number
<br /> PO ,1111 Miss ,Be9ty N1r'3-iom0i o
<br /> ci'scilitys Phone:Fan775,653.,
<br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes
<br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol.
<br /> 1.UN3266,W"e C.wouNeWdi basic,inorganic,n.o s ' 121 t'',,
<br /> (Sodittatt Hycfroxlde,Potassimn Hydtiva e),8,PGR D,. f .,
<br /> M07 DWR
<br /> w
<br /> X 2 UN3266,Waste C nosive 69d(.t basic.,inrarganic,n o a. �w � P 121 t3002 DOBE
<br /> (SO&M Hydroode,Potassion Hy&oxkle),8,PG1 }• �' D007 t
<br /> IXI
<br /> 3 NA►3t177,Hazardous waste,st id,mos-(Lead),0.PGL I' 161 DOW
<br /> X IA,'Non-RCRk Hazardous Waste tJgWd(fir.&,A"Ylate
<br /> 04911011"W) LI
<br /> �` (r"' P X43
<br /> 14.Special Handling Instructions and Additional Information P"Number 2
<br /> 1)ER00164, 070137711-8244 Aitl- 3)ERG#171; t170#? "Q1.15713
<br /> 23 ERM64, 070137711-8244 AN i--,�w r ! � $ � ; }4) 070131670-21877 AP-6 •, •�>-• � c:�,,t
<br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged,
<br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international 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 EPA Acknowledgment 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)(if I am Zsd4all quantity generator)is true.
<br /> Generator's/Offerors Pfinted/Typed Name Signature ' Month Day Year
<br /> 16.Intemational Shipments
<br /> F ❑Import to U.S. ❑Export from U.S. Port of entry/exit:
<br /> ? Transporter signature(for exports only): Date leaving U.S.:
<br /> IX LU
<br /> 17.Transporter Acknowledgment of Receipt of Materials
<br /> �
<br /> Transporter 1 Printedfryped Name Signature Month Day Year
<br /> a ''F
<br /> Z Transporter 2 Printed/Typed Name Signature Month Day Year
<br /> F
<br /> 18.Discrepancy
<br /> 18a.Discrepancy Indiration Space ❑ Quantity EJ Type EIResidue Partial Rejection Full Rejection
<br /> Manifest Reference Number:
<br /> F 18b.Alternate Facility(or Generator) U.S.EPA ID Number
<br /> _J
<br /> V
<br /> raL. Facility's Phone:
<br /> C3
<br /> 18c.Signature of Alternate Facility(or Generator) Month Day Year
<br /> Q
<br /> z
<br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems)
<br /> C 1. 2, 3. 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 /> Printedfryped Name Signature Month Day Year
<br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY
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