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Please print or type. Form Approved.OMB No.2050-0039 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.M de tTr ck' g u er UNIFORM HAZARDOUS 1 '�.8 3 7 WASTE MANIFEST C6d,t G'0015�,"tC�,gS 1 P:>$( rT, •=r0 R.° w7 d FLE 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Wqq baa tinriry 1 y'Awnaster Wale Lodi, CA 95240 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number Adkenced C hf.%T1icW Trorlsport tnc.11 AC i'EINVii CAROOOG705AID 7.Transporter 2 Comany Name U.S.EPA ID Number V1laftdWidea Necoi System, Inc: CAR000175422 8.Designated Facility Name and Site Address U.S.EPA ID Number 2730 Y13t LSC A7R00051552 Int)E. 'i 3th1 ,.st Yuma, AZ 65365 Facility's Phone: 928.34"826 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit and Packim Group if an 13.Waste Codes HM 9 Pf Y)) No. Type Quantity Wt.Nol. Nmft I3f:Y2A fl aPatdou s Wai PSoNd(09 Rters) � Lw / P 2�3 W Z 2. W 3. 4. 14.Special Handling Instructions and Additcpe,I I formation Project Number 109VPJ Documl 9: D220101 0 1) 191255c;VVEY-L,' 'I i- ikrCt `?1 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,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 tens of the attached EPA Acknowledgment of Consent. I cer0ty that the waste minimization statement identified in 40 CFR 261(if I am a large quantity generator)or(b)(ifI am a small quantity generator)is true. GeneratoeslOfferors Pmntedrryped Namef,.. Signature,� A Month ay Ygr 16.International Shipments i— ❑Import to U.S. ❑Expod from U.S. Pont of entrylexic ? Transporter signature(for exports only): Date leaving U.S.: CZ 17.Transporter Acknowledgment of Receipt of Materials n TransPyrt r1 l;rintePd1T Nae -� r Sigpat Fe ir-" 1 } r Mon y r QTransporter Printed/typed Name Signature Month tDay Year h 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type El Residue El Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U ra+- Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed(ryped Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY