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Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) Fr)" Annrnvprl r1AAR imn 9nrn-nA1q EPA Form 8700-22 (F%v. 3-b5) Previous edifions are obsolete. --- 10777.0244 DE TED FACILITYTO DESTINATION STATE (IF REQUIRED) UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST CALOMIN151 I 1 900-746-746 1001154637 G B F 5. Generator's Name and Mailing Address�� pp�� Generators Site Address (d different than mailing address) 8421 (APLTOL AVE. LOOT. CA 95242i' Generators Phone.""81-6161) 6. Transporter 1 Company Name U.S. EPA ID Number ww SHOP,RDS SOLUTIONS, INC CADOM6497 7. Transporter 2 Company. Name U.S. EPA ID Number 8. Designated Facility Name and Site Address,IEMRAICHO CORDOVA; LLG: U.S. EPA ID Number 11A55VMTE:F1=RD. ...:.:.. •, CADD80884183 RANCHO CORDOVA, CA 85742.. 916-351-0� .. - . . , Facility's Phone: 9a 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit HM and Packing Group (if any)) Quantity Wt.Nol. 13. Waste Codes No. T 1. (K40NE,GASOUNE) (0019):• . 0018 352 O w z 2. w O 3. 4. PUMP ALTERS: HOSES B.DEE RIS.:.,,, APPROPRIATE PROTECTIVE CLOTHING SEE ERG /171 .,.., . 15. GEN ERATOR'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 EPAAcknowledgment of Consent. I cerUfy 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. ne lorslOfferors Printed/Typed Name Signature Month Day Year AAA V1 \C�A&J�L" /K, � ZImport . Int m tions S ip en 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 11- Transporter�tedrryped Name Signature Month Day Year O a 8 Q Transporter 2 Printed/Typed Name Si atur Month Day Year F - 1R rlicnrananry 18a. Discrepancy Indication Space ❑ Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection r Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number _J U LL Facility's Phone: In 18c. Signature of Altemate Facility (or Generator) Month Day Year Q Z to Cn 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 0 1. � 2. 3. 4. 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the m fest except need i m 18a Printed1T d Name S qlklure Month Day Year EPA Form 8700-22 (F%v. 3-b5) Previous edifions are obsolete. --- 10777.0244 DE TED FACILITYTO DESTINATION STATE (IF REQUIRED)