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M 393749254 ` .ei 14 Please print or lupe. (Form designed for use on elite (12 -pitch) typewriter.) Form Approved. OMB No. 2050.0039 EPA Form 8700-22 (Rev. 3-05) Previous editions are o sol e. DESIGNATED FACI�OY TO DESTINATION STATE (IF REQUIRED) 10878.2118 UNIFORM HAZARDOUS 1 • Generator ID Number 2. Page 1 of 3. Emergency Response Phone 14. Manifest Tracking Number 007750507 JJ WASTE MANIFEST CAL000167732 (BOO) 424-9300 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) Fedex Freight FM FREGHT (STK) 4520 SOUTH HIGHURY 99 FRONTRIBE ROAR 4520 SOUTH HIGMY 99 FRONTAGE ROAD GeneraSIORM CA 95215 (2091466-2127 ISTOCKTON CA 95215 (209)466-2127 6. Transporter 1 Company Name U.S. EPA 10 Number - - —21st-Centur -Env ronmental: Marta ement o -f -Nevada- -LL-C—-NVD980895338--- -- . �r,1 Company Name 6—Avool�nfft.A � i� E 1 ®r AU.S. A ID Number6,164�1 { 7 t is 8. Designated Facility Name and Site Address U.S. EPA ID Number fiENEIRLINVIRONWRI. HST, LLC DD(i PSC ENVIROUTOL SERVICES 11055 VHITE ROCK ROAR Facility's Phone: CORM, CIA ISM ISM 3SI-agon rjM3nAAL Al 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, 10 Number, 10. Containers 11. Total 12. Unit 13. Waste Codes NO. Type HM and Packing Group (if any)) Quantity Wt Noi. 1' UN1950 VRSTE AEROSOLS (LOOSEPiNX( AEROSOLS) 2.1 ooSq D001 331 ;( Q®� D P W 2' NON-RCRA HAZARDOUS BASTE LIQUID 00 J COW 551 DM P 3' N(Ni RCRA HAZARDOUS VASTE LIQUID (CLEANER) 561 a'NO N RCRA HAZARDOUS VASTE LIQUID (CLEANER) 561 �0 14. Special Handling Instructions and Additional Information 1) 2X (D (1) FEF200-00 - ERG(125) PRO# 2069330213 AERO (2) RZLIQ-00 -. PROD 2015026576 NO (3) Fff IQ -00 - PRO# 2101565443 NO (4) FEFN IO -00 - PROS 1617029234 NON 15. GENERATOR'SIOFFEROR'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 labeledlplacarded, 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 EPAAcknowiedgment of Consent I certify that the waste minimization statement identified in 40 CFR 262.27(a) (d I am a Urge quantity generator) or (b) (if I am a small quantity generator). is true. GeneratoesfOBeroes Printed/typed Name �J Signature Month Day Year (% h102-10 ( t J 16. International Shilirrilints Q Import to U.S. ❑ Export from U.S. Port of entry/exit: = Transporter signature (for exports only): Date leaving U.S.: w 17. Transporter Acknowledgment of Receipt of Materials Transporter T Printed/Typed Name ' _, . ... - ..... _ _ __ • Signature — _ — > — " _ — 'Month.., - Day ' Year a NA Q /�l� 62101 t N( Z Tra Printed(ryped Signature r---> Month Day Ye i\ELOA 18. Discrepancy Ise, Discrepancy Indication Space Quantity ❑ Type ❑ Residue El Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J_ Facility's Phone: w 18c. Signature of Alternate Facility (or Generator) Month Day Year V19. Hazardous Waste Report Management Method Codes (i.e., des for hazardous waste treatment, disposal, and recycling systems) G 1. 2. 3. 4. HI41 -f(iit 6141 1 *H ifHt_ 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the man-" except as noted in item 18a Pdn Name Signature Month Day Year z 1 EPA Form 8700-22 (Rev. 3-05) Previous editions are o sol e. DESIGNATED FACI�OY TO DESTINATION STATE (IF REQUIRED) 10878.2118