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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 _ I nj I , 1, - 1 6 �. J J K 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) CUL G10._TH0PfT1rCJN P0 1310Y 4011 AIiii: DAVE NE531-0,f14 'vV V'H(.,jRM'iV'rM'RD, T VVEST SACPWFENTO,CA 3IRMTON,CA, Generator's Phone.`6-371-'25 0 6.Transporter 1 Company Name U.S.EPA ID Number P iNN 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address PAMOS;04NIRONNIENTAL SIFF%10ES INIC U.S,EPA ID Number 1515-SOUTti Rel,ER RD. WEST SACRANIENT0,Ck Facility's Phone:9 1 6�37111-5;47 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. 1. it SOUD ptii.., UEaiust; 0 3. 4. 14.Special Handling Instructions and Additional Information _jZ �15-1)PR3FILE:�Vf5;WV-31 I E F G#I 7 1 ".R. C0P1TRkGT0R: FANIOS ENIARCONNIEFRAL i-fANIDLER'3 SII()ULD BE`tRAIINEF) .4flD LJSE APPFs�_T�jm PPE XS 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 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 quanti.ty..generator)is true. Generatoes/Offeroes Pdntedrrype;Name Signature Month Day Year 16.International Shipments F- ❑Import to U.S. 0 Export from U.S. Port of entry/exit: K Transporter signature(for exports only): Date leaving U.S.: 04 17.Transporter Acknowledgment of Receipt of Materials Uj Transporter 1 PrintedfTyped Name f Signature Month Day Year C) za 7411Y Z/)A Z_Ire Transporter 2 Printed/Typed Name Signature Month Day Year tY 18.Discrepancy 18a.Discrepancy Indication Space Quantity D Type El Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number U Facility's Phone: LLj 18c.Signature of Alternate Facility(or Generator) Month Day Year tR Z I I H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. -T. 4. 2. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedfTyped Na me Signature Month Day Year V// EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY'S COPY