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Please print or type. Form Approved.OMB No,2050-0039 <br /> UNIFORM HIAZAP-11r! 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAR000088204 1 Fi _7 5-7225 012 7 9 4 4 8 3 FLE <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) ;LO LABEL AT o <br /> Califomia Natural Products UNE, AFFIX 10 AI_ <br /> 1250 E. Lathrop Road ashlynn.amin@cnp.com SIDE OF HAIAR <br /> CA 95330 MATERIAL BILLS 301 <br /> Generators phone: TAB BTlCNS OUT. <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Advanced Chemical Transport Inc./DBA ACTenviro CAR000070540 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> US Ecology Nevada Inc NVT330010000 <br /> PO Box 58Mwy 92,11 Miles S Beatty <br /> Beatty, NV$9803 <br /> raci ity's Phone: 775-553-2203 <br /> ga, 9b.U S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.NOI. <br /> I-NA3077,Hazardous waste, solid,rt_o.s. (Arsenic,Selenium),9 � p 181 D004 DOOE <br /> X P cz <br /> r pt^— 3 Z D007 BOOB D01 <br /> w <br /> W Z <br /> t.7 <br /> 3 <br /> 4. <br /> 14.Special Handling Instructions and AddNonal Information Project Number 219154 Document#: D261557 <br /> 1) ERG#171; 07O'1-. =-11989 CAU- Jx ISo-I' (110 1) <br /> 15. 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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> 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. <br /> Generator's/Offerors Printed/Typed Name Signature Month Day Year <br /> J 16.InternatiVI Shipments <br /> F Import to U.S. El Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> I- Transporte71=6d pod Name/ Signature Month Day Year <br /> a �/ U Q/�. -7 1 /1► -C <br /> z Transporter 2 Printedrryped Name Signature Month Day Year <br /> H <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Typej 1 <br /> ❑Residue El Partial Reaction Full Reaction <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1, 2. 3. 4. <br /> 20,Designated Oaciky Owner or Operator:Certification of receipt of hazardous materials covered by the manifest exceptA noted in Item 18a <br /> PrintedlTyped Name 1, Signature Month Day yew <br /> - I V1,h A-a- I pq P-If IL q I <br /> EPA Form 8700-22(Rev.11-17) Previous editions are obsolete. DESIGNATED F CILITY TO EPA's e-MANIFEST SYSTEM <br />