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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 umber Manifest Tracking N �. ;x y JJK WASTE MANIFEST r �% 1 t i fir. a, 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) V"VS-91 WF J• :aper?f' Generators Phone: : :?a'4 J 6.Transporter 1 Company Name y+y rG.i1U.S.EPA ID Number "'U,?7'V:;'.i ` '*.:N�'\�it";�..�t'•.16iM i:.}+d Fi"73. c74�tt.tfi:.+'S , 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number ROAD WEST SACrVVVIENT0,CA Facility's Phone: c.. 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.Not. O NON-RCRA HAZARDOUS US WA.S"I E LIQUID, (USED GILD z 2. w C7 3. 4. ( 14.Special Handling Instructions and Additional Information IS ;J S . OIL, IVI1XED CII„ ERGID�I71 W l E.R. CONTRACTOR: Mil,"G ENVIRONitf€ENTAL HANDLERS SKOU",D BE Ts?I.(NED AND USE APPROV D PPE 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 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. Generators/Offerors Printed/Typed Name Signature Month Day Year —1 116,International Shipments ' H ❑Import to U.S. ❑Export from U.S. Port of entry/exit: z Transporter signature(for exports only): Date leaving U.S.: W17,Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed-Name Signature Month Day Year C') Month Day Year za Transporter 2 Printed/Typed Name Signature F- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number 181b.Alternate Facility(or Generator) U.S.EPA ID Number J U I Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 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(fyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY'S COPY