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Please print or type. <br />i-Drill Approved. OMB No. 2050-0039 <br />A UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1 Generator ID Number <br />CAL000091449 <br />2. Page 1 of 3. Emergency Response Phone <br />338-785-722!: <br />4. Manifest Tracking Number <br />01 7 8 7 5 3 6 8 FLE Generator's Name and Mailing Address <br />Tr, l,i i'_iy Material Recovery and Solid Waste Inc. <br />30703 S. McArthur <br />Tracy, OA 95378 <br />Generator's Phone: 209-931..3570 <br />Generators Site Address (if different than mailing address) <br />Transporter Company 1 Name <br />US. EPA ID Number Advanced Chemical Transport Inc./DBA ACTemiro <br />I GAr<00007040 .Transporter 2 Company Name <br />ii U.S. EPA ID Number VI ronrnentai Management Technologies <br />I CAR000183574 <br />_F2Litlit <br />Designated <br />Emironniental <br />31915 <br />Parker <br />Facility Name and Site Address <br />Waste Solutions <br />Industrial Ln. <br />noutho4Z. 85344 <br />is Phone: 877.227-0189 <br />U.S. EPA ID Number <br />AZ:2000620478 <br />ga, <br />Hm <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number. <br />and Packing Group (if any)) i 0 Ciantaiiters -- 11. Total 12. Unit <br />NC, Type Quantity VVtiVol 13. Waste Codes <br />w 0 1--- .¢ ce <br />Z u.i <br />iN ';:iotitf(0iiy on- Kc-,Rii, Hazanious Waste Solids-) <br />17/ / 9 z7 c, <br />352 ! <br />------- - , <br />LU <br />CD <br />14. Special Handling Instructions and Additional Information Hroject Number 4U55.:,7 i_kii:;11: illOrli <br />1) EWS6909 rfit..-Y.X.rr--- <br />0.01,09-c.4i173,777- 01444/ 1.4=---7 liA24,17 £(7 v 312'1 CL- <br />. 1,./1.J•11 <br />1- )5 GENERATOR'S/OFF EROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully arid accurately described above by the proper shipping name, an:I 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 • ant and I are the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />I certify that he waste minimization statement identified In 40 CFR 262.27(a) (if I are a large quantity generator) or (b) (ill are a small quantity generator)," n._. Ge toes/Offerors Printedrype Name Signati ,IPP--- Month Day Your <br />Atir't /17-444.117 (Y /1-165-14.1 <br />International Shipments rj <br />1— <br />F.. Import to U.S Export from U.S. Port of entry/exit. Transporter signature (for exports only): Date leaving U.S IX tu <br />l•-• <br />Transporter Acknowtedgment of Receipt of Materials <br />IZ Tran 1 Printed/Typed r Name ,/ / , Si25tiar . Month Day Year <br />2 Printed/Typed 11 z_4 / .v-1 z_--d__ . .1-155,4,4tor arne • Signature <br />t— ° .,-- Month Day Year ...„..-,,.. I I /L I a? le2.- Discrepancy .i <br />Discrepancy Indication Space MI en Quantity Type 0 Residue 0 Partial Rejection Full Rejection <br />Manifest Reference Number: <br />i3 a <br />Em"-1 18c, <br /> <br />u- Facility's <br />Alternate Facility (or Generator) <br />U.S. EPA ID Number <br />Phone: <br />Signature &Alternate .1.-• <br />2 0 <br />Facility (or Generator) <br />Month Day Year <br />Fo- 19. Hazer ous Waste, Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) MI 1, r:3 2. 3. 4. <br />I 20. <br />Printed/Type <br /> Oesnated Facil' <br />Name <br />y Owner or Operator: Certificabon of receipt of hazardous materials covered by the manifest except as nded in Item 18a si st <br />rail PrIrm A <br />rv atii. e <br />A A <br />Month Day Year <br />I 1,) 10. 1-.1 - ions are o su e e <br />SIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />