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Please print or type. 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 7 1' ti 148 JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number RAJAOS WARGW41F.- AL''EIRVICES IP1C, CADDWG3665 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site AddressRAMOtO. EtiMRONN104TAL SERW*F's INC. U.S.EPA ID Number 15715 ar_ILITH RIVER RD. d1fE?,`:+T�';;-.CPjk# ENTO,CR P5697 Facility's Phone:916- 1-17,7.4y ga 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./Vol. 1. D.1ON LRGRA i-IA,'k ;DOOSI tt''r',,"Ty LIC:l..43 (11SE i CAL) O �t _1 W L2. 4 3. 4. 14.Special Handling Instructions and Additional Information C.C. LA 1S, *JTF (1`Y0R: Ri'Llwu-: FNVI1rCL�14�+IF T.AL ib�R#11F.�J HkNDf.ERI.: TO BE TRQW-0 ANO I.45E APPR06,,'f D PPF-- 15. fiF15. GENERATOR'S/OFFEROR'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)(ifl am a small quantity generator)is true. Generator's/Offerors Printed/Typed Name Signature Month Day Year 16.International Shipments F ❑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 LU Transporter 1 Printed/Typed Name Signature Month Day Year a Z Transporter 2 Printedrryped Name Signature Month Day Year F- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejectionj ElFull Rejection 1 Manifest Reference Number: .I 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z rn19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY