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Please print or type. Form Approved,OMB No,2050-0039 <br /> UNIFORM HAZARDOUS1.Generator ID Number 2.Page 1 of P.Emergency Response Phone 4.Manifest Tracking NumberC <br /> WASTE MANIFEST CAR�3&%71 1 888-785-722 017873751 r LE <br /> 5.Generator's Name and MaDing Address Generator's SiteAddress(d different than marling address) <br /> Canary Renevables Corp <br /> 809-C Snedeker Ave <br /> Stockton, CA 95203 <br /> Generator's Ptrone: 209 <br /> 6,Transporter 1 Company Name U.S.EPA ID Number <br /> Advanced Chemical Transport Inc./DBA ACTenviro CAR000O7O54O <br /> 7.Transporter Company Name U.S.EPA ID Number <br /> A , <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> US Ecology Nevada Inc <br /> PO Box 5/8 9d,11 Miles S Beatty NN33001O000 <br /> Beatty, NV <br /> Facigty's Phone: 7755-553-22M <br /> ga. 9b.U.S.60T Description(including Proper Shipping Name,Hazard Class,ID Number, 111.Containers 1i,Total 12,Unit <br /> and Packirrg Group(if any)) 13.Waste Codes <br /> HM Na. Type Quantity Wt.Nol. <br /> 0 1.Non-RCRA Hazardt3us Waste SoIld(Absorbent,Vegetable <br /> Q1O y 491 <br /> 0 � J <br /> s <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions andAddilional Information Prgect Number 452782 Doct.tf ere# 0552 `15 <br /> 1) O7032853"CAU- I x ao Y <br /> 15. G£NERATOR'SIOFFEROR'S CEIMFfCATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassited,packaged, <br /> marked and labeled/placarded,and are in all respects in proper eonditian for transport aocordng to applicable intemationaland national governmental regulations.11 export shipmentand f am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmentof Cone <br /> I certity that the waste minimization statement identified in 40 CFR 26227(a)("d I am a large quantity generator)or(b)(if a small quantityge erator)is true. <br /> Gene sfOSemes PrinledlTyped Name D it L Q Cu em nature Month Day Year <br /> sr� 9"+ '4 !� <br /> 1 16,International Shipments <br /> ❑Impart to U.S, ❑Export from U.S. Port of enlrylexil: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> � <br /> 17.TranspoderAchnov4edgmentofReceipt ofMaterials <br /> t2 Transp4¢��rintedlrypMrK <br /> e � Signature � Month Day Year <br /> a ���''II// 4 <br /> Transporter2 PMtmff pW Name Signature J Month Day Year <br /> F•- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑T e <br /> yp El Residue L1 Partial Rejerdinn ❑Fu0 Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> a Facility's Phone: <br /> Lu 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> a <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) y <br /> 1. 2. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a <br /> PrintedlTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />