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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 J J K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) J&N X-14 TOCk"`t'ON,Cis 96203 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number F"AU101,; ENIARON(VIENTAi. SER^.'t%Ei;INC. t":AOU4CO&%6 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number FsAh+#�C1 Et4`t�BF'CthlhlEhiTA.L SER"�i4CE5+l�C. 8515 SOUTH Rt fER BSD. V EST SACRAMENTO,CA W691 Facility's Phone: 9a, 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.N01. 1. © Z 2. LU 3. 4. 14,Special Handling Instructions and Additional Information -R_ (.0hO ACTOR: RANOIOS E140P INMENTA.L _ > .NDLEM SHOULD BE TR�A6NED 440 USE:APF�f�+~a`-?EES PPI I � '/ 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 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 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 y(if I am a shall quanti ge era r)is true. Generator's/Offeroes Printed/yped Name Signature i Month Day Year J 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: L= 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed[Jame Signature Month Day Year 0 a Z Transporter 2 Printed/Typed Name Signature Month Day Year F- 18.Discrepancy 18a.Discrepancy Indication Space ❑ quantityyp ❑T a El Residue El Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U � Facility's Phone: w 18c.Signature of Alternate 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. 3. 4. 20.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 8700-22(Rev.3-05),Previous editions are obsolete. DESIGNATED FACILITY ERATOR