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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 t.Generalor ID Number 2,Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFESTf' p 5,Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) la D ASSOCIATED'TRACTOR SERMCE.INC 1323 W CHARTER WAY Generator's Phone: T'�V""TON,CA 915206 0.Transporter 1 Company Name US.EPA ID Number t�F ITIONS-IK 7.Transporter 2 Company Name U.S.EPA ID?Dumber 8,Designated Facility Name and Site Address U.S.EPA ID Number --'EWRAN HO GORDOVA LLC. 11055 Wi ROCK RD. RAfi CHO COR f7VA,C,4 05742 Facility's Phone: ga. gb.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 Tripe Quantity Wt.Nol, 13.Waste Codes 0 1' NON-Ill HA�DOUS WASTE IJO+ D a DIRT,0L.GREASE$WATER LLJ z 2 Lu Q 3 4. 1»_Special Handling Instructions and Additional Information rt titH i E U 1 i C"VE CLOTHNG 7-F €=.r r Iti >I EMERGEN0 il,,:UJI I 1 OM I 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 labeled/placarded,and are In all respects in proper condition for transport according to applicable international and national governmental reguiations,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 2152.271(if I am a large quantity generator)or(b)(if 1 am a small quantity generator)is true. Generator'sl0fferor's Printed/Typed Name Signature Month Day Year J 16.International Shipments F— ElImportto U.S. ❑Export from US. Port of entrylexie Transporter signature(for exports only): Date leaving U.S.: w 17.TransporterAcknowledgment of Receipt of Materials ,: For Transporter 1 PrinledlTyped Name Q Signature rG Month Day Year ,p CLQ Transporter 2 Prinfed/Typed Name Signature Month Day Year F- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection a 'e f u 'ate 18b,Alternate Facility(or Generator) her S.EPA ID tp Facili P for, and will acceo Facility's Phone: ailrotor is LU© 18c.Signature of Alternate Facility(or Generator) Month Day Year ZM shipping. 55 19.Hazardous Waste Report Management Method Codes(Le,codes for hazardous waste treatment,disposal,and recycling systems) 0 t 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item ISa PrinledFTyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous:editions are obsolete. DESIGNATED FACILITY TO GENERATOR