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r , <br /> Please print or type. Form Approvdd,OMB No.2050.0639 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone-702W <br /> .Manitest Tracking Numf�er. ,. <br /> WASTE MANIFEST t;ALf�Jt►121 ',�i i 211 W11-534'? 0 2 0� 5091-1.. JJ K <br /> 5.Generator`s Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Hk3ll WHOLESALE MOM 3 4C. <br /> 16014 TILLIE Will QW. L ew.'T 'D'q: Ja <br /> S 4 MKTC'JN,CA 95" <br /> Generator's Phon$3 ' A <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address RA r1Q EWRONMENTAL SERMCES INC. U.S.EPA ED Number <br /> !~A0044l <br /> 161'5 som RPJER RD. <br /> WEST SACRAMERR+iJ.C.& M91 <br /> $1q-371.6;'d? <br /> Facility's Phone: <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit 13,Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.No1. <br /> 1. ;o , P M2 <br /> 1 f` C,J <br /> Z 2. <br /> L <br /> C7 <br /> 3, <br /> 4. <br /> 14.Special Handling Instructions and AddMonai Infonnatoq, <br /> 38iPROFILE# ERG4174 kt' fl1q <br /> KAUDLERS ID BE TRMED AP40 USE APPROVED PPC. <br /> ;M CONTRACTOR., RAMOSE Et' IRON[rlERFi'AC. SEPACES <br /> 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, <br /> marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If expert shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 GFR 262.27(a)(if I am a large quantity generator)or(b)(if i am a sm� Pity generator)is true. <br /> GerrerataesfOfferor ed/Typed Name r Signature .w Month Day Ye <br /> x <br /> 16.International Shipments <br /> EI Import to U.S. ❑Export <br /> ? 11�1.5 , rt�akntrylexit: <br /> Transporter signature(for exports onlyPaving <br /> U.S,: <br /> a 17.Transporter Acknowledgment of Receipt of Materials <br /> H Transporter 1 PnnledrTyped Name ; Signature Month Day lYeyar <br /> Transporter 2 PrintedlTyped Nari Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> F}- <br /> 18b.Alternate Facility(or Generator) U.S,EPA IDNumber <br /> Vt <br /> LL. Facility's Phone: <br /> W 18c.Signature ofAitemate Facility(or Generator) Month Day Year <br /> Z 1 <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> r. <br /> 20.Designated Facility Owner or Operator:Certification of receipt ofhazardous materials covered by the manifest excepos noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17),Previaus editions are obsolete. GENERATOR'S INITIAL COPY <br />