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Please print or type.(Farm 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.Manifest Tracking Number WASTE MANIFEST G B F 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) '38KIOATED 1-{ACTOR SERVICE,INC. i 323 by CHIMTER WAY �TO(i CA 95205 Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number )"i HAZARt1S SOLU11ii INC 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address — U.S.EPA ID Number ,4:M-RAW,1-I0 CORDOVtA,LLC- i VMTE RUCK RE). PAN040 CORDOVA.,CA 96742 Facility's Phone: ga 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 WLNpI. t OkLE- i,t;f ?Uiijl w Lu ^'-" M,GREASE 8 wArIrR 3. 4, i 14.Special Handling Instructions and Additional Information 1-FADS VM TH METPi VW-PROFU$1 oR322i OILY ELl r ;'i�icsr'MA I L Fi;Q i LCs I i VL l LW.! �a 15- GENERATOR'S10FFEROR'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 labe€edlplacarded,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. GeneratoeslOfferor's PrintedlTyped Name Signature Month. Day Year 16.Inlernalional Shipments z ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: E 17 Transporter Acknowledgment of Receipt of Materials OTransporter 1 Printed Typed Name Signature Month pay Year CILe Transporter 2 Printed yped Name Signature �O� G r Day Year 8.Discrepancy -Ir- \ O 18a.Discrepancy indication Space Quantity ❑Type ❑Residue •�rtia!RA lin �� [I Full Rejection �j Manifest Reference Neiiz7ber. 18b,Alternate Facility(or Generator) �,. �w1C 'r Nu W Facility's Phone, Lu 18c.Signature of AReroate Facility(or Generator) Month Day Year Q z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposa€,and recycling systems) 2, 3, 4, 20.Designated Facility fawner 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(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR