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Please print or type. Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator 1D Number 2.Page 1 of 3.Emergency Response Pharte 4.Manliest Tracking Number <br /> WASTE MANIFEST CAL000286489 1 888-785-7225 012808664 FLE <br /> S.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Dragon ESP LTD <br /> 15700 McKinley A\enue sheni.hethea@modemusa.ccm <br /> L erth r°n, eA 95330 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Advanced Chemical Transport Inc./DBA ACTENVIRO CAR000070540 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> ametz GJGAC CiUt/ r A bit QVO2� <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Yuma YES, LLC AZR(}00515924 <br /> 2730 E. 13th St <br /> Yuma, A2 85365 <br /> Facility's Phone: 928-344-9828 <br /> 9a. 9b.U.S,DOT Description(including Ptoper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WI.Nol. <br /> a <br /> UJ 2'Non-RCRA Hazardous Waste Liquid(Oil,Water) DM P 223 <br /> 3. <br /> 4. <br /> 14.Spec I Handling Insh"ons and Additional information Project Number 194900 Document M 0233324 <br /> T9't3t74'- X <br /> 2) 1511702 DRY <br /> 15. GENERATOR'S10FFEROR'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, <br /> marked and labeledlplacarded,and are in all respects In proper condition for transport according to applicable Intemationaland national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowtedgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(III a a small quantity generator)Is true. <br /> Generator'slOfEeroes PrintedlTyped Name Signature Month Da Y <br /> A <br /> ,J 46.International Shipments <br /> ❑import to U.S. ❑Export from U.S. IVPort of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> t2 Te 1 Pint (Typed Name SI nal a Me th Da y <br /> IL rl O I/ { "�.C I lilt, �� V <br /> 11ans; 12 Pr rtted/Typed Name Signa Month Day Year <br /> ✓� r -- 2 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ElQuantity EJType El Residue ❑Partial RejectionEl jection <br /> Full Re <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> uQ. Facility's Phone: <br /> QW 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1. 2. 3. 4. <br /> 20.Designated Facili Owner or Operator:Certification of receipt of hazardous materials covered by the manifest eyR4s noted in Item 18a <br /> Pdnted)Typed Na �� Sig to Month Day Year <br /> Z � I <br /> EPA Form 8700-22( ev.12.17) Previous editions are obsolete. DE N ED FACILITY TO EPA's e-MANIFEST:SYSTEM <br />