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Please print or type. Form Approved.OMB No.2050-00B9 <br /> UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Paga 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL 0 0 0 4 2 4 0 9 1 (800)424-9300 02038,0179 JJ K <br /> 5.Gen tSVCStFrISgiFtt3l;�LREI�AIR Generator's Site Address(if differentthan mailing address) <br /> AkIW HARR[SON ST <br /> S I(T'ON CA 95203 641 SOUTH HARRISON STREET <br /> 209 466 G230 STOCKTON CA $5203 <br /> W <br /> Generator <br /> E.Trans pQ 69's Phone:LWRI M14ONMENTAL SERVICES U.S.FMI'S 2 7 7 0 3 6 <br /> ?.Transpr4LC�' 59'9tCOVFRY SYSTEM !NC. U.S.EPA ID Number <br /> B.De' d�y�igq��� <br /> WNAGtMtNT. 1N U.S.EPA{D Number <br /> US HIGHWAY 95 <br /> AZ 85355 AZR000521146 <br /> Faality's Phone: �9�)344-9828 <br /> 9a- 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity WtfVol. <br /> NpN-RCRA HAZARDOUS WASTE.SOLID(OILY SOLIDS) 0 ,3 35i <br /> Q <br /> 0 /�� t= - <br /> z 2. <br /> LU <br /> C7 <br /> 3. <br /> a <br /> '4.S mcia!Handling Instructions and Additional Information <br /> -Ib'-ENCY CONTACT :CHEMTREC 1-500-424.9300 WOES TERMINAL: CERES CS NAERG#981: 171 *PROFILE#981 <br /> 3 i132623NFt5 OILY 90 ?D5 1D!EnM *APPROPRIATE P EQ MEW <br /> 15. GENERATOR'S10FFEROR'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 Iabeladfplacarded,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,1 certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that thew minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifI am a small quantity generator)is true. <br /> Gen ator's'Offeror's P. Name Sign e _ Month Day Year <br /> .d"6.Intemalional Shipments <br /> [= ❑import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(far exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> LU Transporter i Printed/Typed Name Signature Month Day Ya <br /> Tra *d fA%i-Name n nature Month Day Ye r <br /> _04 nft <br /> I' <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space QuantityType Residue Partial Rejection ❑Full Rejection <br /> Manifest Ref1enoe Nurser.—r- <br /> 10b.Alternate facifi y{or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Ph <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Y ak <br /> a <br /> a <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> D 1' - IJ � I r� 2. 3. q, i <br /> -l�-tT tr <br /> 20.Designated Facility . ner or operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintediTyped Name q Signature Month Day Ye r <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATEp FACILITY 10 GENERAT <br />