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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.M nifest Trackin Number WASTE MANIFEST `/4 (,,,(/C- �' �G z< 213 3642 JJ K 5.Generators,Name and Mailing Addrss Generator's Site Address(if different than mailing address) �✓-�G Com.fc t L F-A-� CA,:--1 /I. 7e-+- t GA 4 5 C- Generator's Phone: f --7,1 6.Transporter 1 Company Name U.S.EPA ID Number CMOS E-V ARONMEWAL:SERVICES W. 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Addres'R�O5 EMARONMENTAL SERVICES INC, U.S.EPA ID Number 1515 SOUiM RIVEiR RD. WEST BAICRAME JTO,CA 95691 Facility's Phone' fr37157A7 9a 91b.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. 1. •,:,;; r_Z. RDOIJS WASTE SOLID (OIL, OEBRIS) 0 QOM �M F 0�V ,QC/lI1 fllllA�tdOvt �A57C GI &u�a 00 i Z 2.ti� pm -j 61 3y� 1 slv 3. 4. 14.Special Handling Instructions and Additional Information ., , R 1 ,:; , ERtaM 71 WC s?o,P0 z G `� hAJ4DLERS 10 HE 7RAiNE0 AND USE.APPRO.MD PPE. 9/3-/ G F4 hr CC-*TMp,CTOR: RAAAOS ENkARONMENTAL ' E'•vtCES 213 / / XSS 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 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 I am a small quantity generator)is true. Generator's/Offerors Printed/Typed Name Signature Month Day Year 16.International Shipments El11-- Import to U.S. El Export from U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials UJ Transporter 1 Printed/Typed Name l� Signature Month Day Year a ,I rJ/ L L! ?`l!'�,21 03 Z Transporter 2 Printed/Typed Name Signature Month Day Year 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 J U LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 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( ev.12-17) Previous editions are obsolete. DESIGNATED FACILITY COPY IF Y ECEIVED THIS MANIFEST,YOU HAVE RESPONSIBILITIES UNDER THE e-MANIFEST ACT.SEE INSTRUCTIONS ON REVERSE SIDE.