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Please print or type. <br /> UNIFORM HAZARDOUS 1•Generator ID Number Form Approved.OMB No.2050-0039 <br /> 2.Page 1 of�I,E <br /> �nyResponse Phone �Kj Number <br /> WASTE s Name and CAL000429774 1 77-2669 . . F L E <br /> 5.Generators Name and Mail g Address Ati t e Safe y anag e r ddress(ifdifferent than mailing address) <br /> Anazon,con. Services.,_ Inc. (DCK1) Anaaon.con Services, Inc.: (DCK1.). <br /> (209)_ .205-0080 2403 West Louise Avenue <br /> 2403 West Louise-Avenue <br /> Generators Fnone: Manteca CA 95337 Manteca CA 95337 <br /> 6.Transporter 1 Company Name <br /> U.S,EPA ID Number <br /> Steric cle Specialty Waste Solutions Inc <br /> r8.Designated <br /> porter 2lCom ny Name—� U.S.EPA ID Number <br /> -� (l rLo �'JL�Facility Name and Site Address f <br /> Rho Chen, LLC U.S.EPA ID Number <br /> 425 Isis Avenue <br /> Facility's Phone:3237766233 Inglewood, CA 90301 <br /> 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> HM and Packing Group(if any)) 11.Total 12.Unit <br /> No. Type Quantity Wt.Nol. 13.Waste Codes <br /> X 1RQ UN281`1,,' Waste Toxic s o 1 i d..s, -,organ,i c,. n o.. 1 .. 00001,.. ,1 <br /> o S. (2,4-D, Silver), 6. 1, PGI'I, (Doll), ERG# GF,,w P 33 :` D00.,5.` <br /> 154 <br /> [if <br /> 2. D016 D027 D008' <br /> c� <br /> 3. <br /> 4. <br /> 14.Special Handling.Instructions aridAddifional lnformahon <br /> zl fiQ9796;(-oxic Loosepack Solids BOY - No .Fertilizers) -:-: a <br /> 15. GEN ERATOR'SIpFFEROR'S CERTIFICATION: I hereby declare that the Contents of this consignment are fully and accurately described above by the proper s)»pping name,and are Classified,pagkago_d, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemationaland national ovemmental <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. g regulations.If export shipment and I am the Primary <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(91 am a large quantitygenerator)or(b)(if I am a s Il quanti. generator)is true, <br /> General sl0fteror'sPrintedR Na A S. ire. �� �V�� •��-:. .- � Monul 4ay Year <br /> _j16:Intemationa!Shipments <br /> 071 03 01 <br /> I-- ❑Import to U.S. <br /> z Transporter signature(for exports only): ❑Export fro U.S. Port of entry exit <br /> LU 17.Transporter Acknowledgment of Receipt of Materials Date leaving U.S;. <br /> Transporter 1 Printed/Typed Name <br /> Signature <br /> a <br /> I:sidro,_Mart.irMonth Dez ay Year <br /> > <br /> :. <br /> Z Transporter 2 Pnnted/f Name Signature <br /> Month Day Year <br /> 18.Discrepancy C <br /> 18a.Discreparwy IndiCatlori Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑ <br /> Full Rejection <br /> 18b.Alternate Facili Manifest Reference Number. <br /> ty(or Generator) <br /> -� U.S.EPAID Number <br /> U <br /> Facility's Phone: <br /> Lu loc.SgnatureofAltemateFacility(or Gene rator) <br /> zMonth Day .Year <br /> 19.Hazardous a Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> w <br /> 1' � J 2. 3. 4. <br /> 20.Desgna all Owner orWOper tor. i ' off ipt hazardous materials covered by the anifesl except a ed in em 1 <br /> PrintedlTy Name Signature <br /> th D y r <br /> EPA Form 8 22(Rev.12-17) Previous editions are obso ete. <br />