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Please print or t Form Approved.OMB No.2050-0039 <br /> UNIFORM HAiARDOW.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.11anifest T ng Number p r� <br /> WASTE MANIFEST CAJ 00=78204 1 st9�78�-7Z? 2`�9 44 Q G FLE <br /> 5.Generator's Name and Mating Address Generators Site Addressr(If diflererd than mating address) <br /> CaWon is Nature{Products <br /> 1250 E. Road as*rnamin0cM.can <br /> hCA 953M <br /> Generators Phmie: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> AdtrterZed Chemicd Transport h--./[)BA ACTeTT4M CAR000070W <br /> 7.Transporter 2 Company Name <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> AduMrlced Chemical Treatment NMOOOZ2Q9627 <br /> 6133 Edith Bhfd NE <br /> Ab.IQuerque NU!87107 <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Gass,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(If any)) No. Type Quantity WINoI. <br /> fr 1.UN1210.Waete PtinM9 hk 3.PGHOF D001 D035 POW <br /> o X P <br /> 214 <br /> z z. <br /> U.1 <br /> cs <br /> 3. <br /> 4. <br /> 14.Special Handfing Instructions and Additional Information PrOjedNlr bff 218154 D(1(trrMN t D26IM6 <br /> 1)ERC31 A, ACT22177 CAA- L O C7P �o 0 7 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declarethat the Contents of this oorr4nmerd are fury and accurately described above by the proper shipping name,aril are classified,packaged, <br /> marked and labeledlplararded,and are in all respects in proper condition for transport according to applicable international and national govemmer>tal regulations.If export shipment and I am the Primary <br /> Exporter,I oertify that'the contents of this consignment oonfona to the urns of the attached EPAApknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity 9 )or(b)(11 am a smati quantity generator)is true. <br /> GeneratorslOfferors Printed(Typed Name Signature Month Day Year <br /> Ir N (� G n! '' /0' , <br /> r- 16.IntemakoW Shipmerds <br /> H 1:1Import to U.S. ❑Export from U.S. Port If Ay*ir' <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter meat of Receipt of Materials <br /> OTransppRer 1 yped Signature r Month Day Year <br /> 'I %a <br /> Transporter 2 Pritded/ryped Name/. Signature Month) D�Wre,, Y <br /> 18.Discrepancy, <br /> 1 Ba.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Fun Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> W 18C.Signature of Alfernale Facility(or Generator) Month Day Year <br /> a - <br /> z <br /> H19.Hazardous Waste <br /> 11Report <br /> ffManagement Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1. 1 H 1 2 4. <br /> 20.Designated Facility Owner or Operabr.Certification of receipt of hazardous ma4Brials Cohered by the manifest except as oared in Item 18a <br />' <br /> Printed/Typed Name r S919— ' j Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />