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1• I Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS I'-Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest TracId Number WASTE MANIFEST ;,�AJ(x;,; y Q 19 �7 4 0 7 8 JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) PRO ON WE FLEET SIEWACES X,,AJC 21110 W fftwow're c—^,+�i+3" . w IT41.CNTC",CA 99.215 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number RAIVIO CAW4A0()% 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number PAC.**RESOLOCE ftL't OVIEFY 3160 EA-131•pw;0 Wm. LOrWFLE114,CIA 9M-3 Facility's Phone:8WA99-'1•'- ga 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)) No. Type Quantity Wt.Nol. 13.Waste Codes 1• W.N IRCIR.A, 11A+i{k.FrYx.d WXSTF ia±>tJ) (..TEP-L W Z 2 3. 4. 14.Special Handling Instructions and Additional Information s�-1)PROFILE# is R(*171 E.R. Ct?h,TRr�C1�OR, �� rav��r rf��trr�:a / 5 �� e f0114 71 ERS :yti0(JL7 lTR.AIWO A44 11F ARF1R0V" PPE UC ; 15. GENERATOR'S/OFFEROR'S CERTIFICATION: 1 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/Offeroes Printed/Typed Name Signature Month Day Year i ? r ; 16.Ifir6mational Shipments f Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year a , QTransporter 2 Printed/Typed Name Signature Month Day Year r- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: s H 18b.Alternate Facility(or Generator) U.S.EPA ID Number Z 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) 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 Printedrryped Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY