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Form Approved. OMB No. 2050-0039 GENERATOR h UNIFORM HAZARDOUS <br />- " - <br />1. Generator ID Number. <br />CAM3122320 <br />2. Page 1 of <br />1 <br />3. Eme ency Response Phone 4. Manifest Tracking Number <br />G B F WASTE MANIFEST 003 623368 <br />Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) <br />&wens Tron9Rrlabon,Inc. 37.45201N, -12100280W 9757 PAIlary Paftway. Daft TX 75221 eentoe Ave.. Ripon. CA 05366 <br />80041064917 <br />Generators Phone: I <br />TransplarixeCom arraix service. tic 1 U.S. Iiiiiikrie6.3 <br />i <br />Transporter 2 Company Name U.S. EPA ID Number <br />. <br />U.) tritAktA)% CAL lit-C-CO kf(Y`i itSAttit" .tretAt- • I C44Z...1)0o k 1-54 27Z._, <br />8 Desiraiggitiarnriagrittiddlig U.S. EPA ID Number <br />7730 E 1311) St. Yuma:VS(5365 AM/00510124 <br />1129-34441428 <br />Facility's Phone: I <br />ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes <br />Hki arid Packing Group (if any)) No. Type Quantity Wt.Nol. <br />NON-RCRA Plaserdow WIPP WO 1,P <br />Abe:Amts. Dirt 4 Diesel DIO 223 <br />I LL 0 <br />2. 140144-ROFtA tisaactots West* Uquod <br />N% Nisei il WO & O Tr 0 723 <br />11 <br />3 * ,00A) 4614 i/M4IRA6 bvA576- Liao.° <br />WATel 1 gl(5e7 o 1 1, D firti 2-7 ° F <br />4. <br />SpecWilikr,66iriftionsrketeli6ilpfmation <br />9b12-Prolio If / 7q....) <br />210C) t i 7/ <br />LA) adZk- •12.2, 4005-ts <br />GENERATOR'S/OFFEROR'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 labeleiplacanied, 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 <br />Exporter, 1 certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />1 certify that the waste minimization statement identified in 40 CFR 262.27(a) (81 am a large quantity generator) or (b) (if I am a al.141uantity generator) is tru <br />Generator's!! 'i •01' I •'yped hk.) c/i i A) 1 Signature Monjh Day Year <br />L <br />,e, <br />f! I 1 9 I 7i <br />...J <br />1- <br />3 <br />International Shipments LIII Import to U.S. Export from U.S. Port of entry/exit: <br />Transporter signature (for exports only): Date leaving U.S.: TR ANSPORTERI Transporter Acknowledgment of Receipt of Materials <br />-s/..9 <br />A)U <br />Signature Monti) Qay Year Transvt7 1..pern ypedpe id <br />L...4/ <br /> /1 / /.--4---- - - 1 I I 67 I 7 ( <br />Traraporter 2 PnntediTyped Name Signature Month Day Year <br />/ tk40An‘rN- X)-)L-41C c - 1 I 146 loct Ill -4-- DESIGNATED FACILITY .18. Discrepancy <br />Discrepancy Indication Space LI Quantity [11 Type Residue Partial Rejection Full Rejection <br />Manifest Reference Number <br />Alternate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone: I <br />Signature of Alternate Facility (or Generator) Month Day Year <br />I I <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />1. <br />+V 1(4 1 <br />2. <br />44 I '1 1 <br />3. <br />-141 q I <br />4. <br />Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as acted in Item 18a <br />Printed/Typed Name Signature <br />. 'Ir‘at. CI' (7k-lucits( I (POrtrii <br />Month Day Year <br />Cul 1 Ks i zi <br />EPA Form 8700:22 (Rev. 3-05) Previous editions are obsolete <br />DESIGNATED FACIUTY TO DESTINATION STATE (IF REQUIRE)