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It <br /> h1 � <br /> Please print of type. Form Approved.OMB No.2050-0039 <br /> lGerwmces <br /> HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manliest Tracking Number <br /> MANIFEST CAC0029MI 909-620-M-cW 019586916 JJK <br /> s Name and Marling Address Generator's Site Address(it different than mailing address) <br /> FedEx Freight 1000 E P.otn R1 <br /> a M Alcoa Rd French Camp,CA 95231 <br /> Benton,AR 72015 <br /> � Phone- 501-860.7904 <br /> vs U.S.EPA ID Number <br /> 6 Transporter 1 company Nameto CAR000277699 <br /> O HEC,Inc <br /> U 7 Transporter 2 Congarry Name U.S.EPA ID Number <br /> m Industrial Waste LltlllZatlon,Inc. CA' s <br /> U.S.EPA ID Number <br /> t I ti Dw7aed Fanny Name and Site Aft=AA <br /> LLC 62P00052t)304 <br /> 2264 E.13111 St <br /> . Yuma,AZ 85365 <br /> F Pthone <br /> 9b.US.DOT Desaptim(rduAng Proper Shipping Name,Hazard Class.ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> •o HM ad pa*m�P P any)) No. Type Quantity WWoI. <br /> y <br /> 1. <br /> 0 Non RCRA Hazardous Waste Sogd (Absorbent w/Cnain Lube 010 f Ohl P <br /> $ z Z p P <br /> a Non-RCRA Hazardous Waste Solid (Cleaning Rags Debris w1 Cnaln 01q C <br /> Plort-RCRA naZar0006 Waste Solid(Cardboard Stained Boxes w/011 ( DM S r/ P <br /> • 4. <br /> y u Speaa Han frig trwiruceons and Additional Information <br /> 90(1) 1%%DM 9b(2) 1x550M 91)(3) IX550M <br /> 3 <br /> c <br /> c <br /> e <br /> Z <br /> ®• 15. �GENE;RATORVOFFEROR'S CERTIFICATION:Thereby declare that the wntenis of dais consignment are fully and aowrately described above by the proper shipping name,ab are dassfied,packs , <br /> akbeledlplacarded,and are In all respects In proper coedit on for transport aaording to appl cab a inlematlonaland naffonal governmental regulations.If export shipment and I am the Primary <br /> potify tl at d e tontentt of this consignment conform to the terms of tie attached EPAAduxWedgment of Consent. <br /> ce tie waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generetor)or(b)(if I am a small quantity generator)Is true.s Pm &Typed Name D O,- 4K SMonth Day Year <br /> 4 <br /> e J 16.International Shpnnenb <br /> 1/0 Import to U.S. El Export from U.S. Port or entry/exit: <br /> w ? Transporter signature(for exp"only,): Date leaving U.S.: <br /> X W 17.Trans Adv arAedamerd of Receipt of Materials <br /> Sign M�nth� Day Year� <br /> 0 Transport anted Typed Name. _ // <br /> a o / ;L-7—�(Jf� <br /> ZTrans 2 Pnnteeyped Name g Month Day Year <br /> QQ Si ria lire <br /> a a <br /> 18.Discrepancy <br /> I Ba Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Fut Refection <br /> 111 <br /> Manifest Reference Number <br /> 18b.Allemate Faalrty(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Fadity's Phone: <br /> W 1Be.Signature of ARemate Facility(or Generator) Month Day Year <br /> Q <br /> 2 <br /> N19.Hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> ILLJ1. 2. 3. 4. <br /> m <br /> M <br /> 20.Designaled Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Be <br /> Pmtedrryped Name ignature Month Day Year <br /> t � . <br /> EPA Form 8700-22(Rev.12.17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e=MANIFEST SYSTEM <br /> � i <br /> Scanned with CamScanner <br />