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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZAi2D0USICA)VO0078204 .Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest tracking Number WASTE MANIFEST 1 wo-7es-722s 1 012794524 F L E 5.Generator's Name and Mailing Address Genera4ors WAddress(if ditierent than mailing address) Califofrfia Natural Produata 1250 E. LRoW ashliyflrt.gnirlGcrlp.c= G�e�aar�s Pnwre� 6.Transporter 1 Company Name U.S.EPA ID Number AdMlclrhd ChteMWA Tm mpoft Inc./DBA ACTerr4m CARODWO540 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Adwrod Chemical Thu tmtent hiI11DOQ 8827 8133 Edith Bh�d NE AbXMM*M NM 87107 Facility's Phone: 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 WtJvol. 1UN3164,Waste ContusiveHquid.aC3fic,inmgarnc,11.0.6_ [IFX OD&w,HydmxMocic Acid),8,PGM I P 551 DO02 W 2Non-RCRA Hazardous Waste Uplir>d(Glyceritse) 554 OF P c'f 3. 4. 14.Speaal Handling Instructions and Additional Information Pa*ad NUMber 219664 DOCU Wd t MUM 1)E RW 54, ACT1O5419 CAA- 100/ N Orr 23 ACT106419 CAAr,( Z /, v7- 15. GENERATOR'S10FFERDR'S CERTIFICATION:I hereby declare that Me oonlere of this consignment are fully and accuracy described above by the proper shipping name,and are classified,packaged, marked and iabeledfplacarded,and are in all respe tS in proper condition for transport acoording to applicable internaliwaland national governmental regulations.If export shipment and I am the Primary Exporter,I oertify that the contents of On o"grnnent conform to the term of the attached EPAAdvmowledgment of Consent I certify that the waste minimization statement idenKied in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. IWSKMrDes PrintedlTyped Name (` nature "7 Yer CA, 4 V2 16.hlemationb6hornents iL.- ❑Import to U.S. ❑E p.1 from U.S. Port of entrylexit Z Transporter signature(for exports only): Date leaving U.S.: CC17,Transporter Acknowledgment of Ra motif Materials Transporter 1 Prin yped Name Day Year d s CO) Transporter 2 PnWed I yped Name Sig re Month Day Year 18.Discrepancy 18a.Discrepancy indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Fall Re taction Manifest Reference Number. 18b.Alternate Facility(o Generator) U.S.EPA ID Number J_ aaldys Phone: w 13C.Signature of Alternate Facility(or Generator) Month Day Year a Z 19.Hazardous Waste Report Management Method Codes(i.e.,oodes for hazardous waste treatment,disposal,and recycling systems) A 2. / �/ 3. 1. 4. /�F 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest exoepl as. 16a Name Signature-- Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR