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Please print or�type Form Approved.OMB No 2050-0039 <br /> UNIFORM HAZARDOUS ' GeneratorlD Number 2.Page 1 of 3 Emergency Response Phone 4.fAani festTrackmg Nunt r <br /> WASTE MANIFEST CAD980814800 2 888-785-7225 016 5 03864 FLE <br /> 5.Generators Name anc Mating Address Generator's Site Address(if different than mailing address) FOLD LABEL AT DOTTED <br /> JR Simplot Co. LINE, AFFIX TO RIGHT <br /> 16777 Howland Rd. SIDE OF HAZARDOUS <br /> Lathrop, CA 953.W MATERIAL BffLS SO THAT <br /> Generator's Phone: 209-858-6470 TAB$TICKS OUi. <br /> rwe[• r <br /> 6.Transporter 1 Company Name U.S.EPA ID Number 019610.1907 <br /> Advanced Chemical Transport Inc./DBA ACTenvtiro CAR000070540 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> Remedial Transportation Si ices (RTS) CAR000181560 <br /> S.Designated Facility Narre and Site Address U.S.EPA ID Number <br /> Advanced Chemical Treatment NMD002208627 <br /> 6133 Edith BW NE <br /> Albuquerque, NM 87107 <br /> Facility's Phone 505••349-5= <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(if any)) 13.Waste Codes <br /> No. Type Quantity Wt,Nol. <br /> 1 UN 1 rile Acetone,3, ll <br /> X DF P 212 D001 F003 <br /> tr fC <br /> w <br /> LU <br /> 2 <br /> 0 <br /> 3 <br /> 14,Special Handling Instructions and Additional Information Document D440385 <br /> 1)E Ri 27'. ACT137t968 JRA- <br /> 15. GENERATOR'SJOFFEROR'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 Iabeledrplacarded.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 EPAAcknowledgmenl 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}(if l am a srr i quantity generator)is true_ <br /> GeneraloesiOfferor's Printed/Typed Name Signature Month Day Year <br /> S 31 17-7 <br /> — <br /> 16 Intema,onai Shipments <br /> F ❑Import to U.S. ❑Export fin.US. Po of entrylexit: _ <br /> ? Transporter signature(for exports only): Date leaving U.S-: <br /> C 17.TransperterAcknowledgrrent of Receiot e`l <br /> w <br /> Transporter 1 Panted Typ d Name Signature Month Day Year <br /> a fSG <br /> Transpo ter 2 Pnr,_P'7,kned Name S Month nay Year <br /> 18 isr-epancy <br /> 18a,Discrepancy Indication Space El <br /> Quantity Type El Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 18h Alternate Facility(or Generator) U S.EPA ID Number <br /> U <br /> LL Facility's Phone: <br /> 18c.Signature of Alternate Facility(or Generator) 4onth Day Y,:ar <br /> a <br /> ILLI <br /> Z <br /> N19.Hazardous asfe Pe Vort nagement Method Codes(I e.,codes for hazardais waste treatment,disposal,and recycling systems) <br /> 0 1. 2. a . <br /> 20 DqsQnaied F circ wnc- Operator Certifica,opofreceiptofh.yd.Ls alEnals covered by the rranrfqst ntted in/6.18a <br /> Pdnt y N S' ore th nay Y ar <br /> Ut <br /> EPA Form 8700-22(Rev 12'17) Previous e diorts are obsolete. E.SIG D FACILITY TO EPA's e•NIANIF f `L YS I EM <br />