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Form Approved,OMB No.2050-0039 Please print or type. 1.Generator ID Number 2.Page 1 of 3.Em"rloy Response Phone 4.Manifests Tr`aaccking Number UNIFORM:HHAZARDOUS CALUtD0253231 o`v88 �A WkSTE ANIFEST Generator's Site Address(if different than mailing address) 5.Generator's Name and Mailing Address "00Y SHOP i.. 941 M(*FAT BLVD MANTECA, CA 96336 Generator's Phone: 209 823--4462 U.S.EPA ID Number 6.Tiansporter 1 Company Name u n Ol?R i .7 5 2 4 0'i l'ACTFtt RESOURCE RECOVERY SERVICES U.S.EPA ID Number 7 Transporter 2 Company Name 8.Designated Facility Name and Site Address U.S.EPA Number PACIFIC RESOURCE RECOVE'F?Y SERVICES CA13U(i 325:40ta 315© EAST PICO BLVD. OS ANGELES, CA 90025 Facility's Phone: (800) 499-714S 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class.ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No Type. Quantity Wt.Nol. tUN12 3, v c.v o PGII, RQ, (0001) LU 2Nt N RCPA HAZARDOUS WASIFF- LIQ _ LLJ (MIXED AUTOMOTIVE FLUIDS) - 3N WN-RCKA--RA Z&R1W-U$ WASTE- GLYCOL). (CA4-IF�RAIIA �i &i�ttr ' 0�1tV-� ;US-WAS -14"fill ;JN*) (;.-Al TFORNIPr C3F 14 Special Handling Instructions and Additional Information _461) AP # 6:325 ` b2) AP# 5-�ib �tJ-t) htt �# •63�^-9�4�_ fts 9-is'S39y +.iLOVES, GOGGLES & PROTECTIVE CLOTHING 24HR EMERGENCY CONTACT- KTitK WALUr:!Ri f RQ : 9b1 ) 128 9b2) NONE - 4->- -- I IIIIIi Illll IH!!{1111 IIIN lNl!1!111 III#1 ILII#illi Illi ANSPORTE' , rrnv, �! 1 Hp.ts ra 1 i4Lti 15. GENERATOR'SIOFFEROR'S CERTIFICATION: 1 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. 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. Month Day Year Generator's/Offerors Printed/Typed Name Signature 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entrylexit: F— Date leaving U.S.: ? Transporter signature(for exports only): W 17.Transporter Acknowledgment of Receipt of Materials Month Day Year LU Transporter 1 PrintedlTyped Name - / _. Signature ' CK a Month Day Year Z Transporter 2 PhnledfTyped Name Signature Q [>! 18.Discrepancy Quantity Type 18a.Discrepancy Indication Space L1 Residue ❑Partial Rejection ❑Full Rejection ❑ ❑ Manifest Reference Number: U.S.EPA ID Number 1 8b.Alternate Facility(or Generator) F— J_ U u- Facility's Phone: Month Day Year UO 18c.Signature of Alternate Facility(or Generator) Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 2.1 3. 4 0 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Month Day Year PhntedlTyped Name Signature GENERATOR'S INITIAL COPY EPA Form 8700-22(Rev.12-17) Previous editions are obsolete.