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Please print nor type. (Form designec ;e or (12 -pitch) typewriter.) <br />UNIFORM HAZARDOUS rlGenerator's US EPA ID No. Fo m ApP`oved OMB No 2050-003,9WASTE MANIFESTManifest Document No 22. Page Information in the shaded <br />(Continuation Sheet) H 1 1 1 0 8 0 5areas is not required by Federai <br />23. Generator's Name <br />9 9 S .. b.....a _ 4 of �_ law. <br />COUNTY OF SAN JOAQUIN DEPARTMENT OF PUBLIC WORKS L. State Manifest Document Number <br />1810 EAST HAZELTON AR - 1 0 5 7 0 0 5 <br />QTnrvmhL r,n gc.nc.4 M. State Generator's ID <br />24. Transporter Company Name <br />25. US EPA ID Number N. State Transporter's ID <br />26. Transporter Company Name O. Transporter's Phone <br />27. US EPA ID Number P. State Transporter's ID <br />Q. Transporter's Phone <br />S DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) 29. Containers 30. 31 R <br />Total Unit Waste No. <br />a. ��/ �C /► '"jl 83Al`/ 1 No. T pe Quantit WtNol <br />b. � Gb/ F poQ�j � vJ�I�Z <br />,.ax , c� <br />C. o,::, <br />�acjiv� Sa/% ,!�.v.s. �/ ooh <br />A/I 8 /3 , JT CCcr �G/ Lin,) Card / <br />E , 2�0G>C I // ah /G <br />R �' . o in 'r-, l./. � . II <br />C mid <br />A e. ,D,F�//� <br />T <br />O <br />R <br />I T. <br />1-07 <br />h <br />S. Additional Descriptions for Materials Listed Above <br />wMC)3 7(Cg5 X /O) T. Handling Codes for Wastes Listed Above <br />9 wMos 744&59 C/ x*0 c <br />�8 c� wir4ns 7¢¢7757 C t x20 � /3a <br />3 Spejl Information <br />WMO5 79-452C / x /o /53 <br />T <br />R 33. Transporter _ Acknowledgement of Receipt of Materials <br />A <br />N Printed/Typed Name <br />Signature <br />s <br />P <br />R 34. Transporter Acknowledgement of Receipt of Materials <br />T Printed/Typed Name <br />E Signature <br />R <br />F <br />35. Discrepancy Indication Space <br />I <br />L <br />IYI <br />Style CF 18 Labelmaster, An American Labelmark Co., Chicago, IL 60646 (800) 621-5808 <br />® PRINTED ON RECYCLED PAPER <br />USING SOYBEAN INK INK <br />Date <br />Day Year <br />Date <br />Day Year <br />EPA Form 8700-22A (Rev 9-88) Previous ell' are obsolete <br />ORIGINAL -RETURN TO GENE ERA, <br />