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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST a:A.u`tf4•Qi�4,i� 9 �!-w'1-'747 T 1 JJK 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) I?AM0,S2 f�1ti1.%il'.i^�41`'1'.i it'ii_S,R',,�II.:E1; li'ii. F+.Cl. O!-V�1 1515 S,RNIER•.ESO. WFSTSA R/i,"AENi0.rA V%591 ybt�st,a.tyiEPtTn %� 9639, Generator's Phon%,_--.•- -'& 6.Transporter 1 Company Name" U.S.EPA ID Number i"t',k AQG E0811fa01dMENO f�.SE::-'-`12ES IPA;. 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number ?�=�fid=3�F?!�i'�'•lf�C3i�l�y4E(:S�i~._.^ER7I�C.E�?i�1L. ��#�??4t��, 1515 SGIJ TH RIVER RD, V?EST S.ACRAMEN70.(,'A SeI591 Facility's Phone #,z-;Tr,- ,,t;, 9a• 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. 0 1 NON 1♦ RA H ZLkF!Ys` US 'AIASTE LIQUID AJSEDtJIL, :d 77� � W Z 2. W 3. 4. 14.Special Handling Instructions and Additional Information e T 171 951j USED 011-,MIXED 011L. E.P. 0.-YA1rF.AGT0R: RAMC+S ffi410ROi+ll.°is~NTAt- HANDLERS SHOULD BE TRAINED AND 1Y7.F fi PFtO)rFn- r'i°E -ZI i 'lt ' _�• 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this&nsignment areTully and accurately described abov`P y the proper shipping name,and are classified,packaged, marked andlabeled/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(Pnif I am a s all quantity generator)is true. Generators/Offerors Pn d ed N me Signature ! Month Day Year 16. ntemationalShipments �. F -ED Import to U.S. ❑Export from Ul ort of entry/exit: z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LLI Tr ns orter 1 Pdnted/Typed Nae Signal "% o �, f 9 Month Day Year z IL ' Transp iter 2 finned/TypedNVaine' Si aldFe �r" 'Month Day Year t-- 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 V 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) LU 1• j pp 2. 3. 4, Ll20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a ?Y I I n I I Pdnle55yped�Name f r; Signature �!' �6� Month Day Year EPA Form 8700=2 ;(Rev. 2-17) Pre !666 editjpKs are obsolete. DESIGNATED FACILITY COPY IF YOU RECEIVED THIS MANIFEST,YOU HAVE RESPONSIBILITIES UNDER THE e-MANIFEST ACT.SEE INSTRUCTIONS ON REVERSE SIDE.