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Please rint or e. Form designed for use on elite(12- itch typewriter.) Form Approved,OMB No.2050-0039 <br /> P tYP ( 9 2-pitch) YPe 1 PP <br /> UNIFORM HAZARDOUS 1 Genera?or 10 Number 2,Page 1 of 3 Emerg?ncg P.esxanse Phone d.Man'rfest o(] <br /> WASTE MANIFEST 0110 9 4891 91 FLE <br /> 5.Generator's Name and Mailing Address Generator's Site Address of different than mailing add,-ess) <br /> Simpson Strong Tie Inc. <br /> 5151 S AIRPORT WAY <br /> Stockton, CA 95206 <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name U S.EPA ID Number <br /> Adtienced Chemical Transport Inc. (SV) CAR000070540 <br /> 7.Transporter 2 Company Name US EPA IG Number <br /> ILVaai 6 L-,- RG(O✓o-Y as "► CARCXOl?5Y7-2- <br /> 8 Oesigrated Facility Name and Site Address LIS EPA f-Number <br /> Yuma YES, LLC <br /> 2730 E. 13th St AZR000515924 <br /> Yuma, AZ 85365 <br /> Facility's Phone 928-3444S28 <br /> ga 9b.D.S.DOT Description(including Proper Shipping Name;Hazard Glass,10 Number. 10.Containers 11.Tota' 12,Unit 13,Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.tVol <br /> a <br /> Non-RCRA Hazardous Waste Solid(Oil}r Sotid ) � �, ? <br /> o — <br /> z 2 <br /> W <br /> F <br /> 3. <br /> 4 <br /> 14,Special Handling Instructions and Additional Information Project Numb r 148641 Document# D178510 <br /> 1) 174810 SIY- — (SXSiSOTM <br /> Ls-/0, 57sz4r? <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contends of this consignment are fully and accu-ately described atove by the proper shipping name.,and are cuss=fed:packaged, <br /> marked and labeledtplacorded,and are in all respects in proper condition for transport according to app€i the .ational ental regulations.t€export shipment and I am the Primary <br /> Exporter,I ceruty that the contents of this consignment conform to the terms of the attached EPA Ackn dgment of Cenj <br /> I c ' the waste minimizaIjon st ement identified in 40 CFR 262.27(a)(if I am a large quantit eneraton or"j 1 IJ m a ,,Vaag'.aerator?�s imc <br /> Gen . toe s *; ed? a =gnalure en , ay ear <br /> i` <br /> J 16.m0ffiatronil ipments { { Portcfent exit: <br /> 1— ❑Import to ❑Exy <br /> Z Transporter signature for ex onlv): Date leavin DISA—. <br /> tY 17.Transporter Acknowledgment of Receipt of Materials <br /> WW Tr porter t Printe Signature onn ay ear <br /> %,0. a <br /> Z Trans net 2 Pnnted y Name g u ` onth ay ear <br /> °g R C �a�vv J�- -- SES-•1- UiLll l'?- <br /> t— <br /> t8_Discrepancy <br /> 18a.Discrepancy Indication Space Ouarl ity Type j <br /> U Residue ❑Partat Rejection <br /> _ Fill Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) D.S EPA ID Number <br /> _J <br /> V <br /> LL Facility's Phone: <br /> W 18c.Signature of ABernate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> UJ 1 ` 2 3 4 <br /> JJi AL <br /> 20.Designated Facility0•wner or Operator.Certificatb of receipt of hazardous matenais covered by the manifest except as noted in Item 18a <br /> PnntectTyped Name Signature Mcrth OayYear <br /> U-3 l <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE-(IF REOUIRED) <br />