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Please print or type. PhForm Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response one 4.Manifest Tracking Number WASTE MANIFEST �.fl948-311-5 '17 ' a JJ K 5.General is Name and Mailing Address Generator's Site Address(if different than mailing address) .4 ;A6lo ; ,tot ke r'.A, J 529 0 Generator's Phone: r y� 6.Transporter 1 Company Name U.S.EPA ID Number Rarnm ErYYirortmenta1 Servicers Inc. 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Rarnes Envtonmeftal Seryices Inc- 11516 5 River Rd. West Sapnmiy*ntb CA X91 Facility's Phone: i,+. ` "I ' 1+T 7 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.Nol. 11.010NPvr- A HAZARDOUS VASTE ISOLIC DE KAL, R' `' 0 I Z 2. W _... rg 3. 4. 14.S ecial Handlin Instructions and Additional Information 1�l 1 110FILE RQ-41i 7'1 HANDLERS TO BE TRAINEE)AN[.'��r',Il PPE ECD RAM�rS ENVIRONMENTAL. 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 quantity generator)is true. Month Day Year Generator'slOfferor's PrintedlTyped Name Signature ,j 16.International Shipments Ll Import to U.S. ❑Export from U.S. Port of entrylexit: ZDate leaving U.S.: Transporter signature(for exports only): W- 17.Transporter Acknowledgment of Receipt of Materials Month Day Year LU Transporter 1 Printed/Typed Name Signature w' O a Month Day Year Z Transporter 2 Printed/Typed Name Signature I- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V LL Facility's Phone: Month Day Year W 18c.Signature of Alternate Facility(or Generator) Q Z N 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 4. D 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.