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Form Approved.OMB No.2050-4039 <br /> Please or type. <br /> UNIFQRM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Rbsporase Phone 1.Manifest Tracking Humber JJK- <br /> 5 WASTE MANIFEST W:� 127 - 9-16-371-6747 <br /> 5.Generator's Nameand Mai#ing Address Generator's Site Address(rf difrereht than mailing address) <br /> TERES!TRUCKING IidC- <br /> M\ACT0R RD. <br /> 1_001,CA 9� <br /> Generator's Phori _ i'- U.S.EPA ID Number <br /> 6.Transporter 1 Company Narne <br /> EMARONFAC-NT4L SERVICES INC. i,wtXu3i ,f- <br /> U.S.EPA ID Number <br /> 7.Tr porter 2 Company Name <br /> ell <br /> 8.Designated Facility ame and Site Address � U.S.EPA ID Nunsber <br /> `fEOUA ES TECHNICAL S0LUTION$ CATMI4079 <br /> 1125 HEpiSLEY STREET <br /> RICHM0tVC1,CA 94801Fadiity's Phone�'2�'2� <br /> 9b.U.S.DOT Description 0nduding Proper Shipping Name.Hazard Class.ID Number, ifl.Containers 11.Total Q.Unit 13.Waste Codes <br /> 9a. Quantity MJVOI- <br /> HM and Packing Group(if any}) No. Type <br /> 1, <br /> WN RCR?. Ho'k aDOUS WASTE SOUia kmTEEL SHAVING ,- <br /> r�G <br /> z 2. t <br /> U.1 <br /> CD <br /> 3. <br /> 14.Special Handling Instructions and Additional Information <br /> 98-1)PT OFILEP ERGM71 <br /> E.R.'CONTRACTOR: RAMOS ENVIRONVENTAL <br /> HANOLER5 SHOULD OF TRAINED AND USE APPROVED PPE <br /> 15. GENERATOR'&CFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,arra are classified,packaged, <br /> marked and labeledlplacarded,and are in MI respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAclmowledgment of Consent. quantity generator}is true. <br /> I certity 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 q <br /> Month pay Year <br /> GeneratoesrOffarofs PnntedlTyped Name 5ignature 1 <br /> i <br /> f i <br /> 4 <br /> 6.kniamational Shipments Import to U.9.. ❑f_xport from U.S. Pat of entrylexit: <br /> i— Date leaving U.S.: <br /> Transporter signature(fa exports onl# <br /> of 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed7yped Name Sgnature MoP� Day 7w <br /> 0 <br /> a Month Day Year <br /> aZ Transporter 2 Printedlr ped Name , signature <br /> oCM <br /> � r <br /> PJ4 LA <br /> 18.Discrepancy It��tt <br /> 18a,Discrepancy indication Saace n - DType I_7Restdue ❑Parflal Rejection ❑Ful Re)ection <br /> Manifest Reference Number: <br /> U.S.EPA ID Number <br /> 18b.Alternate FaciKy(or Generator) <br /> J <br /> U <br /> W Facility's Phone, Month Day Year <br /> im 18c.Signature of Alternate Faality(or Generator) <br /> a <br /> � 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1' 2 3. 4. <br /> ff 0. ignated Facility Owner or Operator Certification of receipt of hazardous materials covered by"manifest except as ndted sn Item 18a- Month Day Year <br /> 7PnAQed,Name Slgnatwe- <br /> DESIGNATED FAC(L1TYT0 GENERATOR <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. <br />