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Please pent or type. Form Approved, OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number <br /> WASTE MANIFEST CAR000186668 1 888.785-7225 012808443 <br /> 5, Generators Name and Mailing Address Generators Site Address (d different than mailing address) <br /> American Biodiesel INC DBA Community Fuels <br /> 809 SNEDEKER AVE STE C <br /> STOCKTON, CA 95203 <br /> Generators Phone: 2094664823 <br /> 6. Transporter 1 Company Name U.S. EPA ID Number <br /> Advanced Chem icaLTransport Inc./DBA ACTENVIRO CAR000070540 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 8. Designated Facility Name and Site Address U.S. EPA ID (lumber <br /> Advanced Chemical Treatment iL <br /> 6133 Edith BtW NE NMD002208627 <br /> Albuque", NM 87107 <br /> Fadlity's Phone: 505•c349w220 P <br /> l ; <br /> ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers- 11 . Total 12. Unit <br /> HM and Packing Group (d any)) 13. Waste Codes <br /> No. Type Quantity WLfVOL <br /> cc <br /> 1 •NA3077, Hazardous waste, solid, n. o.s. (Methanol ,Toluene) , <br /> X 9 , PGMi r}'� DM r .�r� F 35Z F001 FQO 1 <br /> 1`003 <br /> Z 2. <br /> UJ <br /> 3. <br /> ------------ <br /> 4. <br /> i <br /> 14. Special Handling Instructions and Additbnal Informationn / Project NUmber 189111 Document #: D229069 <br /> 1) ER(3#171 ; ACT729% AMAu VJ, OO /D <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> marked and labeled/placarded, and are in all respects in proper condition for transport accordN to applicable intemational and national governmental regulations, if export shipment and I am the Primary <br /> Exporter, I certify that the contents of this consignment conform to the terns of the attached EPAAcknowiedgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a) (d I am a large quantity generator) or (b) ('dl am a smAll quantity generator) is true. ; - <br /> Ggmeraiors/0fferors Printed/ryped Name Srg Mon <br /> th YI <br /> "O <br /> 16. International Shipments <br /> it ❑ Import to U.S. ❑ Export fromU. . Port of entry/exit <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> W 17, Transporter Acknowledgment of Receipt of MaterialsUJ <br /> j <br /> tE Mransden yp,ned Name !Aw"Otor <br /> Sig re OF Mor „ems <br /> a Transporter 2 Pdnted/Typed Name <br /> Signature 0: r9 Month Day Year <br /> r— <br /> jf <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space <br /> El Quantity ❑ Type Residue <br /> ❑ ❑ Partial Rejection ❑ Full Rejection j ' <br /> Manifest Reference Number. <br /> 18b, Alternate Facility (or Generator) U.S. EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: ; <br /> UJ 18c. Signature of Alternate Facility (or Generator) Mont Day Year <br /> Q <br /> Z <br /> h19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 0 1 77� <br /> 3. 4. <br /> 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a I " <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's ewMANIFEST SYSTEM <br />