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-� Please print or type.(Form deli ped for use on elite(12-pitch)typewriter) III1IIi�� 1H1IHlIl11111i1�ll�iii'lilllili�l�l Form Approved OMB No.2050.0039 UNIFORM HAZARDOUS 1.Generator to Number 2.Page 1 of 3,Emerrcy Raswriiie Phone 4 Manifest Trackng Number ,7 7- -, WASTE MANIFEST F 5 ti�009 011385186 F L E 5.Generators Name and Waiting Address Generators Site Addle"(if different than ma 79 address) ll 1 Ct Or I a Secret H Al`q tlir taI Gecii�ctfl 1 1 4i "Or J4761963050 Pacific Ayenuo 4950 Pacific Avenue. So.�kce 425 4 tac1K,totri. CA �5207 Stockton. CA 05207 Generator's Phone, -; 1 6.Trantiporrier I Company Name U S,EPA to Number w4woo�4 " 7.Transporter 2 CM08'ry Name U.$ EPR IDNumber 3 lit 175422 8 Designated Facility Name and Site Address i i,i its J- ';e L t. U.S.EPA 10 Number 3O E. 13 t h t V ki IV 4. A2 EA 5 2 11- Facility's;Ptiorie: ga, 9b,'U.S 007 Darcripil;an fmcludit,q Proper Shipping Name,Hazard Class,1D Number, 10 Containers 11 Total 12.Unit HM and Packing Group iifaiiy)i No Type Quantity WtJVol, 13,Waste Codes 1,Non IlUffi ria2arclowi waite. I I a i.i I d ci-�c 0 0 11 0 Lot i ons 3. a. 14. pf clai Handling Instructions and Additional Information f.. i I 070E t e H P a!.t I A eA L a u i A 15. GENERATOWSIOFFEROR'S CERTIFICATION: I hereby cfecare!hat the contents of th's ccwgriniant are fully and accurately described above by the opershipping name,afd are classified,nackaged, marked and lebelecflpliacarded.Ewa are r,ai!respects in PTOPet condition for transi.crt au:ording to applicable in*naliunal and national governa,e/ntZegulations If ,Port shipment and I am the Primary Exponier,I certify that the contents of this consignment conform to me terms c`the attached EPA Acknowledgment of Co�idm I certify that the waste minimization statement identified in 40 CFR 262 271,a)(iO am a large quantity gent /I air,a small quantity rator)�s true. ener o(s/offerors PrintedlTyped Name Sgrawr, 7,L D u,-naA r. 0 r L I ilon. I)5—Y 7ear 16 iftemationalShipments import to U.S. El Export from U.S. Port of an exit: Z Transporter signature for exports only l: Dole lea US.: 17.Transporter Aoknowtedgment of Rereip; ":+a:e lie LIJ Transporter I PralleatTyped Name grau,re ',`,ort. ay ear 0 Anthorriv rlacir z Trans rMn!" Day ear 18 Discrepancy 189-Dscrepancy Indication SoaceUuanhty Residue 0 Tyne El Partial Rejection ❑Full Rejection hilarrJest Reference Number i 8b.Alternate Facility for Generator} U.S.EPA ID Number U I Facitit's Phone. UJ 19c S gnatf Allenrtite Facility for Generator) Month Day Year 19.Hazardous Waste Report Management Method Codes(i.e.,dollies for hazardous waste treatment.disposal,and recycling systems] UJI 1 2 3, C3 H I I 20,Designated Facility Owner of Operator Certification of raceipt of hazardous matieralscovered by the manifest except as noted it Item arra PrintediTypeo NaLml Month Day Year It ,�I Q(�I.1/;,�t I , I�-- 1 10 7— i u,u �—, li EPA Form 8700.22{Rev.3-05) Proi,�ous editions are obsolete. CA':'CII€1 01ATION STATF(IF REQUIRED)