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Y Please printer type. Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAl.000350320 I 2W522-3271 -7t G B F 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) JM EQUIPAdEN`!< CO.-MP WECA 321 SPRECKELS AVE MAN'TlEeA,GA 05336 Generator's Phor;&9-522 32/1 A 05 6.Transporter 1 Company Name U.S.EPA ID Number AIVILRICAN VALLI Y WA-SIL-UIL,INC GAR00027231V 7.Transporter 2 Company Name U.S.EPA ID Number WORLDWIDE rt�c:avl+RY SYS IF-MS INC GAR000175422 8.Designated Facility Name and Site Address, U.S.EPA ID Number Vt3AA�t Yds:t.IN�iS t l~ThAI+ISPirft l�Af,;Ii.iTY` A7140lTik524146 6500 U$HIGhWAY 95 1� k`t f�,+l4,A- 853Wr Facility's Phone:2f.�-"i�{•�dTti28 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit and Packing d an 13.Waste Codes 9 Grou HM P(� Y)) No. Type Quantity Wt.Nol. 1."I-RCRA 1'iAZARI).01:f, WAcI'.83011t7,A 8'ii9REi[''f T Oil ? 0M 480 P 352 O Z 2. W 3. 4. 14.Special Handling Instructions and Additional Information lyfdOFILiv# Tt 28-14hlii,3 AfMME1N'T'S,qll. E:ftCi# 17'I L-ME_'GF_NGY CONTAGT'ROY 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, 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 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 smallquantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature �----�----�.- Mon Day Year ,j 16.International Shipments I- I ❑Importto U.S. ❑Export from U.S. Port of entry Z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of M rials Transporter W yped meVie'/ Mo Ye Ve Tran o r t PrIntjdfTyped Name Signature V6nth ay Y r r 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Typej j Residue Partial Rejection Full Re ection Manifest Reference Number: r- 18b.Alternate Facility(or-Generator) U.S.EPA ID Number _3 5 LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) Notice: State of California requires Uj c 1. z. 3. generator to photocopy and mail to 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18. DTSC with 30 days: Printed/Typed Name Signature P.0 BOX 400 Sacramento,CA 95812-0400 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY