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Please print or type. 4 GENERATOR 1. I _ UNIFORM HAZARDOUS WASTE MANIFEST I. Generator ID Number 0 A ij g S 2 .0 6 0 1 2 1 2. Page lot 1 3. Emergency Response Phone 61-JC .1.7.,:)-30:-:.iL: 4. Manifest Tracking Number 1171782281 JJK 5. Generatoes Name and Mailing Address At JOHN PAI I Ri(feeneritoes_Site Address (if different than mailing address) JR SIMPLOT COMPANY SIMPLOT GROVYER SOLUTIONS PO 80)( 29955 - 4863 CARPENTER RD FRESNO CA 93729 . 1 STOCKTON CA 96215 Generators Phone: 2 fl 0, P. is 7 7 A 9 7 I 6, Transporter 1 Company Name U.S. EPA ID Ntanber MP Environmentat Services 1 C A T 0 0 0 2 4 2 4 7 Transporter 2 Company Name U.S. EPA ID Number I Designated Facility Name and Site Address U.S. EPA ID Number WASTE MANAGEMENT, INC 7 KETTLEMAN HILLS 35251 OLD SKYLINE ROAD - KE1 ! L.EMA.N CITY CA 93239, , Facility's Phone:P S , ci q,c/B fr)nri_ . , - 0 6 4 6 1 7 ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes Hm and Packing Group (if any)) No. Type Quantity Wt Nol. 1. - NON RCRA HAZARDOUS VIASTE SOLID 6.11 q.0100 2. - 3. 4. 14. Special Handling Instructions and Additional Information i)PRonLP # CA g210, ROUND UP SPILL C.:I-PAN UP 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, marked and labelediplacarded, 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 Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 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 a small quantity generator) is true. GereratoeslOffges Printed/Typed Nav Cy ki. Gu 1 Signature --, Month Day Year --trjt 41 1 41_ I ,),--. 7- r-- g 16. International Shipments Import to U.S. Export from vs..' ...---../Port of entry/exit: Transporter signature (for exports only): Date leaving U.S.: TRANSPORTER 1 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Sig re Month Day Year ---- 11tiL.N1 Piee0(*.k (1 1 13 I L-1 1 -,?-1 Transporter 2 Printed/Typed Name ' nature Month Day Year I I I I , 4---- DESIGNATED FACILITY --3- 18. Discrepancy Discrepancy Indication Space Quantity Type El Residue Partial Rejection Full Rejection Manifest Reference Number: Alternate Facility (or Generator) U.S. EPA ID Number Facility's Phone: I Signature of Alternate Facility (or Generator) Month Day Year I I 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 11\2 ',.--),. 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a Printed/Typed Nan%Signature Month Day Year 16 ON (16 c,, .., ., _______..__ Ckfel 0 e,,i)1 1 I G'I .A t-il al Form Approved OMB No 2050-0039 EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR