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Please ndnt or tvne_ (Form desioned for use on elite (12 -Ditch) tvoewritec) Form Approved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number 1008960494 JJ K WASTE MANIFEST CAF 0CIL! 2G31098=c�380-�&1 5. Generators Name and Mailing Address Generator's Site Address (if different than mailing address) J&.R: Enalrorimental, Inc 1680 Sof_rth Camino Real, Suite 4 .San Bernardino, C-: 924011 951-5137-7264 Generator's Phone: 6. Transporter 1 Company Name U.S. EPA ID Number J&R En'Aronr iental, Inc CA -F-0002031 _G 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number Fro Arnblente, Sr':. De C.V. (Planta Noreetei , , ,,'. -,., ,', Carr. tvinnr.?rr_ : Fe�m-�a K.1'4 G'Rr��r 011-52-81-83i;taJ1tiicrre%,tdL 1`0EXI;O Facilily�=*�La_ _ s Phone: ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity WtNol. 1i IPi126=, FVaste Paint Related fviateriai, 3, F'rSlf 8 CF 6400 P D0101 612 O Z 2. LU 0 3. 4. 14, Special Handling Instructions and Additional Information 9t 1.) $AG1F 15. GENERATOR'S/OFFEROR'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. marked and labeled/placarded, 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 EPAAcknowledgment of Consent. I cerfify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (d I am a small quantity generator) is true. Generators) s Printed/Typed Name signature Month Day Year J � 16. International S ipments Import to U.S. Export from U.S. Port of entryiexit z Transporter signature (for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials �2 Transporter 1 Pdnted, typed Name Signature Month Day Year a �- 9- 7` 1 13 QTransporter 2 Printed/Typed Name Signature Month Day Year F- 18. Discrepancy 18a. Discrepancy Indication Space ❑ Full ❑ Quantity ❑Type Residue Partial Rejection Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA 10 Number J U tai Facility's Phone: w 18c. Signature of Alternate Facility (or Generator) Month Day Year a Z N19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) � 1. 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pdntedrryped Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)