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F'K SHTPM 221.04871 Illllllflilillllllilllillllllllflllil n05767066SKS 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.Manifest Tracking Number WASTE MANIFEST _'3�::)i' ', a 1005767066 SKS 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) RO Lail) Inc. 8830 W L.xnne Rd 1'RACY CA ?5304_•91.09 Generator's Phone: 209-836--0965 6.T�nspgde � or P�n 't 1me -Y n r=My U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number C iiLb 8.Designated Facility Name and Site Address z NC. U.S.EPA ID Number SACRAMENTO CA 91 °I°r a —$`713 f�A(rti(1C14t +4` 1 Facility's Phone: ga 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit No Type Quantity Wt.Nol. HM and Packing Group(if any)) 13.Waste Codes I 1 i.li ii-N;: ^ra is ttt i+: +tiliS Wr• °; L, LI >U,iL, o (AQUEOUS PARTS WASHER SOLUTION) W Z 2. w C7 3. 4 14.Special Handling Instructions and Additional Information '4 HR EMERGENCY # 800-468-176(), �j j- I c KL EFI11 `;11TH -C re�r?FiIT- 'f!?i'rr P't' �F-M T0 4ETy^ It I Tf Cly,�1 ,^ r erl' f Ai--'R , , 15. GEN ERATOR'SIOFtFEROR'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, 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. GeneratorslOfferor's Printed/Typed Name Signatur Month Day Year u �{ a2 13 1 J 16.lntemationaf Shipments z ❑Impo t to U.S. ❑Export from U.S. Port of entry/exit Transporter signature(for exports only): Date leaving U.S.: LW 17.Transporter Acknowledgment of Receiot of Materials Transporter 1 Printed/Typed Name Signature Month Day Year a �U-p �- 107 ( 3 17 Q Transport Printed/Typed Name Signatur6 Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: jZ 18b.Alternate Facility(or Generator) U.S.EPA ID Number _J U Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year F Z Z 5-)CD Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) C3 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/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY T16 D INATION STATE (IF REQUIRED) ,., X 14 G 6 0