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Form Approved. OMB No. 2050-0039 <br />A UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1. Generator ID Number <br />CAC003157228 <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone <br />1-888-647-2857 <br />4. Manifest <br />016996354 <br />Tracking Number <br />FL E <br />iiii;tdo.r • s Natand ailing Address Gierator's Site ens ii different than mailing address) <br /> <br />110t diteca Road If aste a Wnr 18° <br />Manteca, CA 9533T Manteca , CA 95337 <br />Generator's Phone: I <br />Transporter 1 Company Name U.S. EPA ID Number <br />Atlas Environmental Solutions 1 CAR000295220 GENERATOR kaiirrirOrritifeiiiiilaanagement Technologies. Inc. 1 atilisre6133574 <br />i <br />Diaticiiiimit ,iitid. dbdlutions. Inc. U.S. EPA ID Number <br />ustriiii.ane AZR 000520478 <br />Patter South, AZ 85344 <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 />HM and Packing Group (if any)) No. Type Quantity Wt.Nol. <br />Non-RCRA Hazanious Waste, said (Unbolts!) DF <br />*352 <br />4 <br />i <br /> 1 <br />i <br />1 <br /> <br /> <br />Document: 0329846 <br />1 <br />14. S ecial Handling Instructions and Additional Information <br />1 EWS13147 <br />Bil to: Atlas <br />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, aid are classified, packaged, <br />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 <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment 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) (ill am a small quantity generator) is true. <br />Generators/Offerors Printed/Typed t*me Signature Month Day Year <br />tr,-6..1.2, ci)(,). 4, , _c_;-; , • e , I ,A ---- _I 16. International Shipments b Export from 'Us:9A Port of entry/exit: r- Import to U.S. <br />Transporter signature (for exports only): Date leaving U.S.: TRANSPORTER I 17. Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 Printed/Typed Name <br />VI <br />Signature Month pay Year <br />t 1 L•51-2-- ---7-- I 3 I I 512-2-- i, t ) fri ce-yvt .M - • es "t - <br />Transporter 2 Printed/Typed Name Signature Month Day Year <br />- <br />'Va..) \ "T.- I . I.3 I7-13.12;z- <br />18. Discrepancy <br />Discrepancy Indication Space Quantity Type Residue Partial Rejection Full Rejection <br />Manifest Reference Number: I .4-- DESIGNATED FACILITY Alternate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone: I <br />Signature of Alternate Facility (or Generator) <br />Month Day Year <br />I I <br />19. Hazardous Waste R port Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />1. <br />2. 3. 4. <br />20. Designated Facility • vner or Operator: Certification of r ceipt of hazardous materials covered by the manifest e as ncted in Item 18a <br />Printed/Typed Name Signatur Month Day Year <br />I , <br />Il3 iklig <br />......--. ... - ... • ...... ....., -,..... ,n A I- - IIII A kilrffe-r Cl/C•TGRA <br />EPA Form 8700-22 (Rev. 12-17) Previous edition are obsolete.