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IN :midiS41.2311 376752 1241574 Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) Form Approved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 5) Previous itins re obsolete. 10852.2028 DESIGN A D FACILITY TO DESTINATION STATE (IF REQUIRED) UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest king Number 0 0 7 7� 1953 JJ WASTE MANIFEST CAL000167732 1 ( 800) 424-9300 5. Generatoes Name and Mailing Address Generator's Site Address (if different than mailing address) Fedex Freight FEDEX FREIGHT (STK). 4520 SOUTH RIMY 99 FRONTRGE ROAD 4320 SOUTH R16MMY 99 FRONTRGE RONA GanerM§01111 CR 93215 (209)466-2127 ISTOMON CA 93215 (209)466-2127 '6. Transporter 1 Company Name U.S. EPA ID Number 21st Century Environmental Management of Nevada, LLC INVD980895338 7. Transporte mpany Name U.S. EPA ID Number `--L t i -4 -e" � ,n�t1a �'L 1?53�Z 8. Designated Facility Name and Site Address U.S. EPA ID Number GENERAL ENVIRONWRL MGT, LLC DB( PSC ENVIRONPif RL SERVICES 11835 UHITE ROCK ROAD Facility's Phone: RflK= CQRIQVR,CR 95742 (916) 331-0900 CAD980884183 ga_ 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit13. Waste Codes No. Type HM and Packing Group (if any)) Quantity WL/Vol.® 1 -RCRA HAZARDOUS BASTE LIQUID (LRUaRY DETERSEHT) 7q F551 r.- Q-1 � DM P W 2. UN1253 VRSTE PAIRT RELATED MTERIRL 3 P6II 111)(8001) DO01 331 X Q DM 107— P ni a. RCRR HAZARDOUS PASTE LIQUID561 3 8 Q 14. Special Handling Instructions and Additional Information (I) MIQ-00 - PROD 2153515556 ptlH (2) FEWN-02 - ERG(120) PROD 2143239275 9PRPt (4) ZLIQ-0O - PROD 2073531994 NOH (1) 1 XM 6r L 2, 1 X$'S Crly, ) X 110 Cr 15. GENERATOR'SfOFFEROR'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 EPAAcknowledgment 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. Generatoes/Offeroes Printedrryped Name4 t / Signature Month Day Year i Z 7-14 10 Z1 I— 1 . International Shipme is M mport to U.S. ❑ Export from U.S. Aolt of entry/exit: ? Transporter signature (for exports only): Date leaving U.S.: IX W 17. TransporterAcknowledgment of Receipt of Materials T sporter 1 Printedrryped NameSi atmm Month Day Year a9 1 I%.117-11 a QT s er 2 Pri d Nam , Sign ay Year 00"d RIM f-biscriancy Ale I b. Discrepancy IndicetionSpace Quantity ❑ Type; ❑ Residue ❑ Partial Rejection ❑ Full Re)ection Manifest Reference Number. 18b. Alternate Facility (or Generator) U.S. EPA ID Number J ' rJ tai Fadlitys Phone: 18c. Signature of Altemate Facility (or Generator) Month Day Year h19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) G 1. 2. 3. 4. N1I2 H141 H1I1 H111 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the marl exi#pt as noted in Item 18a Name Month Day Y/eea�ggr 02 1l} ') EPA Form 8700-22 (Rev. 5) Previous itins re obsolete. 10852.2028 DESIGN A D FACILITY TO DESTINATION STATE (IF REQUIRED)