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P!eaca nrint nr tvna lFnrm dpsinnad fnr use nn elite (19-nitch) typewriter.) Form Approved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) J UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number 008960492 JJ K WASTE MANIFEST t:Y•FCr�t [ 1t ;1Cra voU - �'^� ='c'�+ 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) !&.R Enalrcrnrnental.. Inc !jP--Enulrnrental, ?nr jr8ajSouth CReal, Suite d 1i Ave San 8ernany!r _ CA. 9240; . Generator's Phone: 6. Transporter 1 Company Name U.S. EPA ID Number J::,G En l-Ontrlent3l, Ino 0 Rp[r12>_r_,1[ra 7. Transporter 2 Company Name U.S. EPA ID Number B. Designated Facility Name and Site Address U.S. EPA ID Number Pro Arntdente, S-61. De C.V. (Pintdclre5te) i_ij- U 1i Carr. 43.5 L` erpvtE jimenez, NI_ Niexdoo ni;-s2-e1-;.3z}. Facility's Phone: - 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Gass, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt.Nol. L '- _IN126.�, -Aca5te Pairit FC-Iate0 hi3ter131, 3, P 11 14 .1F: 11900 P D01 612 O -- Q Z 2. W O 3. 4. 14. Special Handling Instructions and Additional Information 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, and are classified, packaged, marked and labeledlplacarded, and are in all respects in proper condition for transport according to applicable intemational 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 (am a small quantity generator) is true. Generator'slOfferoes Printed/Typed Name Signa u Month Day Year 1 .Intemational Shipments ❑ Import to U.S. El Export from U.S. Port of entry/exit: Z Transporter signature (for exports only): Date leaving U.S.. W17. Transporter Acknowledgment of Receipt of Materials Tr er 1 Print ped Name Sign Month Day Year ZQ Transpo yped Name Signature Month Day Year H 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantityy ❑ T pe El Residue ❑Partial Rejection Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J_ V LL Facility's Phone: W 1 Be. Signature of Altemate Facility (or Generator) Month Day Year Q Z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1. 2. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Ba Printed/Typed Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)