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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number... WASTE MANIFEST - JJ 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) f A1�tOS ENVIRONMENTAL S:Er<'•';:u.:r ii•ii P O.BOX 401 tVF11;TMACKA.MEEPITry,C X91 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number ;AAmo 9 EI�ly ?e5fifM1FPIT1!t_ ER'vIGF:, Ihlt`. 7.TransportEr 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site AddressU.S.EPA ID Number S R4AQEhlti�i(kOt11.�EIuI'zii aEf t:'it: ' i!'!i . Ists 301 H RfvT!R•RO, NEST SACRAMiEWO,CA 961l Facility'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 HM and Packing Group(if any)) No. Type Quantity•, Wt.Nol. 0 _...__ z 2.UJ 3. ; ! i 4. 14.Special Handling Instructions and Additional Information 71 i.10ROWEPT AL ti.hNDL FS SFiC:ULF) .: :,tI2>_D .AND 1.35E APPRO7 Ir-l)PPF- 15. GEN ERATOR'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 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 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. Generators/Offerors Printed/Typed Name SignatureMonth Day Year 16,International Shipments F- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: z Transporter signature(for exports only): Date leaving U.S.: St17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printedrryped Name Signature Month Day Year t QTransporter 2 Printed/Typed Name Signature Month Day Year r- 18.Discrepancy '18a.Discrepancy Indication Space quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number U Facility's Phone: L, 18c.Signature of Alternate Facility(or Generator) z - Month Day Year a w19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1, 2. 3. 4. 120.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 6700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY'S COPY