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Please print or type. Form Approved. OMB No. 2050-0039 A GENERATOR ,- UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1. Generator ID Number <br />CAC003199760 <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone <br />800-556-9090 <br />4. Manifest Tracking Number <br />023295294JJK <br />Generators Name and Mailing Address Generators She Address (if different than mailing address) <br />SWIFT TRANSPORTATION 3735 IMPERIAL WAY <br />2200 S 75TH AVE STOCKTON CA, 95215 <br />PHOENIX AZ, 85043 <br />Generator's Phone: 602-600-6293 I <br />Transporter 1 Company Name U.S. EPA ID Number <br />ANCON MARINE 1CAD980737068 <br />Transporter 2 Company Name U.S. EPA ID Number <br />CROSBY & OVERTON 1 CAD028409019 <br />Designated Facility Name and Site Address U.S. EPA ID Number <br />CROSBY & OVERTON CAD028409019 1630W. 17TH STREET <br />LONG BEACH CA, 90813 <br />Facility's Phone: 562-432-5445 I <br />ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit <br />Ai and Packing Group (if any)) No. Type QuantityWt.Nol. 13. Waste Codes <br />NON RCRA HAZAROUS WASTE SOLID <br />2 DM 600 P 7 352 <br /> <br />7 <br /> <br />-I <br /> <br />_J <br />14. Special Handling Instructions and Additional Information <br />Line 1: wastestream: 99611-82; <br />15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby dedare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable intemational 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) (dl am a large quantity generator) or (b) (if I am a small quantity generator) is true. <br />Generators/Offerors Printed/Typed Name Signature Month Day Year <br />john soria 1 john soria 1 10 1 15 1 2022 <br />.,-1 <br />Z <br />16. International Shipments <br />Import to U.S Export from U.S. Port of entry/exit: <br />Transporter signature (for exports only): Date leaving U.S.: <br />17 w <br />Ig: <br />0 ra_ <br />u) <br />= <br />< <br />ce <br />1- <br />17. Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 Printed/Typed Name Signature Month Day Year <br />ABRAHAM PRECIADO 1 ABRAHAM PRECIADO 1 10 1 15 1 2022 <br />Transporter 2 Printed/Typed Name Signature Month Day Year <br />LISA CHRISTENSEN 1 LISA CHRISTENSEN 1 10 1 18 1 2022 14-- DESIGNATED FACILITY --0- 18. Discrepancy <br />Discrepancy Indication Space EJ Quantity nTYPe Residue Partial Rejection Full Rejection <br />Manifest Reference Number <br />Altemate 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 I <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />1. <br />H141 <br />2. 3. 4. <br />20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />Printed/Typed Name Signature Month Day Year <br />PABLO BARCELO 1 PABLO BARCELO I 10 1 20 1 2022 <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM