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Pease arint or type. Form Approved.OMB No.2050-0039 UNIFORM HAZAR IZ$ Generator Ip Number + 1 of 3.EmA e;7;Response Phone 4.Manifest Tracking Number WASTE MANIFE Tf'GARM782134 7225 0122'83755 F L E 5.Generator's Name and Mailing Address Goneratons Site Address(if different than mailing address) Califonva Natural Products 12M E. Laithrm Road ashiynn.afniracnp.com Lathrop, CA l Generatcr's Phone'. 6 Transporter 1 Ccmpany Name U.S.EPA ID Number Adualrlced Chemical Transport Inc./DBA ACTENVIRO CAR000070540 7.Transporter 2 Company Name U.S.EPA ID Number I 1 8.Designated Fadity Name and Site Address U.S.EPA ID Number A"nced Chemical Treainw t 8133 Edith Btvd NE NMOOD22O 2/ Aibugljwgw, NM 87107 Facility's Phone: -340-5M 9a. 9b.U.S.DOT Descriptton(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)} 13.Waste Codes � No. Type Quantity WtNol. Ix -X- w UJIX 2iJN 1881,`►Vesta Sadlur>fr aide,8.1 ,1'GA IF P 551 M03 P1OE i r este azic solid.Inorganic,mos.(Potassium X Ferricyanide), 6.1 ,PGM pE P 561 DOW 'UN 1993,Waste Flammable liquids,n.o s. (EtharKA Diacetyo, � 561 owl X 3,PG11 OF 0, p ( 14,Special Handling lnstnrctonsand AdditonalInformation ! p.r,; t Mrr9 W 1837EO WCt 0 �1( ./ ' ,`!�^ 3)EfWVM51; ACT89484 CAA-_I 2)ERSM53, ACT89454 £'AA- 1 1_� 4)ERCW128; ACT89456 CAA, 'y_ 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,aM are classified,packaged, marked and labeled)placarded,and are in ap respects in proper condition for transport according to appiicable intemaiional and national govemmentat regulations.if expert 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 certity that the waste minimization statement identified in 40 CFR 262.27(x)(if I am a large quantity generator)of(b)(ifl am a small quantity generator)is true Gkenneratoes/Offeroes Nrited(Typed Name !, +{/ a Signatu re A D Yw` P,>ch 1, CL) 16 Intentboral Shipments F ❑Import to U.S. ❑Export from U.S. P Df entrylexit: _ Z Transporter signature{for exports only): Date leaving U.S.: W 17.Transporter Ac knowledgmert of Receipt of MaterialsUJ $, Transporter 1 Printedfryped Name Signature,_ Z Transporter 2 PrIntedlTyped Name Signature Monfh Day 7w — 18 Discrepancy 18a,Discrepancy Irdicabor Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejecti6n ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number V LL Facility's Phone: LCL] 18e.Signature of Alternate Fac6ty(or Generator) Month Day ver. Z W19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) Q 1 `f 2 3. 4. 20-.-bAignated Facility Owner or Operator:Certification of receipt of h rdous materials covered by the manifest except ai rioted in Item 18a Pnnted/Typed Name Signature Month Day year EPA Farm_87 0-22( 2-1t&u 'ebhb6s'afeobW6te, / DESIGNATE AC LI CUM IF LVED THIS MANIFEST,YOU HAVE RESPONSIBILITIES UNDER THE e- EST ACT.SEE INSTRUCTIONS ON REVERSE SIDE.