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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS ll.GeneralorlDNurnber 2,Page i of 3,Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST r A ^ P4 M-' ''21r 019295411 FILE <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Pelican Renewabies <br /> 3028 Navy Dli'we <br /> tockton. CA 95206 <br /> Generator's Phone:2.2 , 7 1�1 <br /> 6.Transporter 1 Company Name U.S EPA ID Number <br /> - 1ICAL TRANSPORT La C CARG00O7054O <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> igernenf Technol--r?ies CAR0O0183574 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> nwronrn ntal Waste S:3 -it:-Dns AZR000523478 <br /> '.1915 Industrial Lr. <br /> Parker Sou da <br /> th AZ 853 _ <br /> Facility's Phone: <br /> ga, 91b.U.S-DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10-Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. type Quantity Wt,Nal. <br /> Cr 1 •;on-RClt1 Ha:aids—ts!1';tstt. S;>Il t t( <br /> 2 DM 3/ 0 <br /> z 2. <br /> W <br /> 3.Non-RCRA Hazardous Wasif_i jgoid (Ehphed Round lit,) / <br /> � F)F 3 1C> <br /> Non-RCRA HazardottS Waste Solid(013-Solid Debris) <br /> 14.Special Handling Irslructions and Additional information Project Winnib9f &SOBER Docuinei t <br /> 11 EVVS3275O FEL- x Ssaf 3) Evvs327s4 PEE-_ Lena,r <br /> 4) EWS32756 PLE= _l- x.Od <br /> 15. GENERATOR'SlOFFEROR'5 CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by[he proper shipping name,a d are classified,packaged, <br /> marked and Iabeledlplacarded.and are in all respects in proper condition for transport according to applicable international and national governmental reguialions.If export shipment and I am the Primary <br /> Exporter,I cert'rfij that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent, <br /> I cerlify that the waste minimization statement identified In 40 FR 262.27(a)(if I am a large quantity generator)or{b)(ifI am a small quantity generator)is true <br /> Generator'slOfteror's Printed/Typed Name Signature Month Day Year <br /> r f 6 8 /3 1.2y <br /> j 16.International Shipments <br /> i= ❑Import to U. ❑Export m U.S. Port of entrylexit, <br /> ? Transporter signature{for exports only): Date leaving U.S.. <br /> 17,Transporter Acknowledgment of Receipt of Materials <br /> w14 <br /> w Transponer 1 Prrntedl Typed a Signature Month Day Year <br /> a- /� / 1 4±:� 4 <br /> Z Transporter 2 Print !Typed Name Signatu MnZ g <br /> Year <br /> 16.Discrepancy <br /> 183.Discrepancy Indication Space <br /> Quantity ❑Type ❑Residue ❑Partial Rejection El Full Rejectien <br /> Mandesl Reference Number: <br /> 181p.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> Lai Facility's Phone' <br /> w 18c Signature of Alternate Facility(or Generator) Month Day Year <br /> t— <br /> a <br /> z <br /> N19.Ha rdous Wa eport Management Method Codes(i.e.,codes for hazardous waste treatment.disposal,an recycling s stems) <br /> 0 1, 2. 3. 4. <br /> 20 Desig ted Facility 0wrer or Cperator Certilcaiion of re ipt of hazardous materials covered by the manifest excep noted m m a <br /> PrintedfTyped Na a qYeEPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO PA's e-MANIFEST S <br />