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1111111111111111111111111111111111111111111111111111 -0039 <br /> Please print or type. Form Approved.OMB No.2050 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Trackin Number <br /> WASTE MANIFEST <br /> CAl_t11710427614 1 8775-71 c-b �14�115 81 F L E <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address <br /> a;-;th & Bodv Wor kq (_,= Bath n Bodv Works#6j <br /> 20995=4396 5308 PACIFIC AVE. SHERWOOD MALL/ SPACE 6 5-3-08 PACIFIC AVE <br /> -:1 <br /> Generator's Phone: S!LCt1 T t7('�. CA r��c« F STOCKTON. CA 950-07 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> tericut ie SDerialty Taste Solutions Inc i�NS�}I=f4i1109=�+ <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address ur U-S.EPA ID"lumber <br /> General Environmental Int, LLC <br /> 11855 White Rock Road <br /> Rancho Cordova. CA 9�7A2 <br /> Facility's Phone: qjp,,:zFjL7fl C A Q7184183 <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 NLA7ol. <br /> 1171� <br /> 1' LI^1195�_l. Waste Aerosols. [flammable, (each not 1 Cf fur T 3;,1 D�N <br /> cc X <br /> a exceeding 1 L caoacit'7l3 cel. ERG#1216 <br /> z 2. <br /> 217 <br /> f <br /> 3. <br /> a <br /> t <br /> 4. t <br /> 14.Special Handling Instructions and Additional Information 10 110 904(Aerosols, ;I d M M R b l e) <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name.ard are classified,packaged, <br /> marked and laLeledlplacarded.and are in all respects in proper condition for transport according to applicable international and national governmental regulafions.!f 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 slgVement identified in 40 CFR 262.27(a)l I am a large quantity generator)or(b)(i I am a small quantity generalorl is true <br /> N Signature �",gjLpehalf of Limite Month Day Year <br /> GeneratorslOfferors PrintedlTyped <br /> 1 is �3 <br /> J 16.Tgernational Shiomen Imp. to U.S. ❑Export from U. . Port of entrytexit: _ <br /> l Date leaving U.S.: <br /> Z Transpor•-er signature(for exports oniyj: <br /> W 17.TransporterAGkrowledgment of Receipt of Materials <br /> H Transporter Printed/Typed Name Signature Month Day Year <br /> Ir L 1 <br /> a Johnnv Haroer <br /> Transposer 2 Primedr'Tyoed Name Signet a Month Day Year <br /> z <br /> Q <br /> t•- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space L1 Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> F D 18b.Altemate Facility(or Generators U.S.EPA' Number <br /> J <br /> U <br /> ua Facility's Phone: Mo-cf` Day Year <br /> W 1821.Signature of Alternate Facility for Generator) <br /> a <br /> z <br /> 19 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal.and recycling systems) <br /> 0 1 2 3 <br /> LA <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardo ate.'ais covered by the manifest except as noted in!tem 18a _ Month Dayl Year <br /> Printed Typed Name Signature <br /> EPA Form 8700 22(Rev.12-17) Previous editions are obsolete. - <br />