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.r - Please print or type.(Form designed for use on elite(12-p tch)typewriter.) Form Approved.OMB No,2050.0039 FGenerator's ARDOUS 1.Generator iD Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number [1 meand Ili Cq ,111tIt 007467266 JJK me and Mailing Address - .vGenerator's Site Address(if di ferent than mailing address) Hre C'�eparrrxera,utf!tJrren 3ua 1 117.2 Ni Main St F3chtru�4iAvn ;; 'di3nlC4si,i 35x3 -Mar1teca CA 95336 Generators Phone: 6-Transporter 1 Company Name U.S.EPA ID Number PARC''pecianyC:nnlractors CAR"145Q$85 7,Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address RHCJ-c;-HBA. LLC U.S.EPA ID Number 4L'I ISIS ilvgr�r-w,. CA00083(34432 i tnglewfnod CA 9031t)t Facility's Phone: 323-77FIl 9b.U.S.DOT Description indudi Proper Shi i t lame,Hazard Class,ID Number, 9a. p ( m9Shipping 10.Containers 11.Total 12.Unit HM and Packing Group{if any)) 13.Waste Codes No, Type QuantityWt.IVol. i 1, ?:Y14i1;,C rroBtve 5�(ids.7cr>ttc N.0 S- (49CFR 1172-101 c t'1?,8.(13.1 O 1 OF 100 352 P`� " it Uj Z 2. W c7 j i 3, 4. 14.Special Handling Instructions and Additional information F-.RG bock in Cab •1Arear appropnatln pens i pr Ai ivee esquipmeiv when harx#irig !!1)351 EFtr"i#154 E:FiERAt 2011-04-04 ,toll 6222 15. GENERATOR'SICFFEROR'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, 4 marked and labeledlptacarded,and are in all respects in p oper condition for transport according to applicable international and national governmental regulations.If export shipment and f am the Primary t Exporter,I certify that the contents of this consignment cor form to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in W CFR 21(if I am a large quantity generator)or(b)(if I am a small quantity generator)rs true. GereratorsVlorors PrintedlTyped Name Signature Month Day Year i J 16.International Shipments j ❑Impar(to U.S. ❑Export from U.S. Port of entrylexit: z Transporter signature(for exports only): Date leaving U.S.: UW 17.Transporter Acknowledgment of Receipt of Materials X Transporter 1 PrintedlTyped Name Signature p � � 1 , I .,�,f' Month Day Year ZTransporter 2 PdntedlTyped Name -'- ' Q < S ature Morth Day Year 18.Discrepancy i 18a.Discrepancy Indication Space i ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Fuil Rejection 11 Alternate Facility(or Generator) Manifest Reference Ni U.S.EPA ID Number L) k Facility's Phone: LOU 180 Signature of Altemata Facility(or Generator) Month Day Year a a 19.Hazardous Waste Report Management Method Codes(Le.,o des for hazardous waste treatment,disposal,and recycling systems) n 1 2. 3. 4. L20. ignated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Typed Name Signaturer Man h Day Year EPA Form 8700-22(Rev.3.05) Previous editions are obsolete GENERATOR'S INITIAL COPY