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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST020183692 F L E 5.Generator's Name and Mailing Address Generator's S e dress it erenl lnar mailing address) SUPER KING FOOD CENTER MAILING SUPER KING FOOD CENTER 8626 N. LOWER SACRAMENTO ROAD STE. 20 1449 W. MARCH LANE STOCKTON, CA 95210 STOCKTON, CA 95207 Generator's Phone:(925)20 1-9511 6.Transporter f Company Name U.S.EPA ID Number Atlas Environmental Solutions AR000295220 7.Transporter 2 Company Name U.S.EPA ID Number Hazardous Material Transportation Inc. ICAROW1&3822 8.Designated Facility Name and Site Address U.S.EPA ID Number Samex Recycling Technologies, S.A. DE C.V. Andador Vecinal No. 3902, Col. Valle Redondo 02-IV-13-18 Tijuana, MX22330 Facility's Phone: 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. UN1263, Waste Paint related material, 3, II 331 '0001 o X ` DF Z) P Z N1993, Waste Flammable liquids, n.o.s. (Methanol, Ethanol, DF ` 1 P 214 ID001 X Isopropanol), 3, II, RQ UN3175, Waste Solids containing flammable liquid, n.o.s. D001 331 X (Isopropyl Alcohol, Plastic Packaging), 4.1 , If DF P 4. 14.Special Handling Instructions and Additional Information ument: 1. Primary Exporter: Samex Environmental Srvices, Inc 1)SMX q1(qS ERG#128 2)SMX '1000 ERG#128 3) 819 Anchorage PLace, Chula Vista, CA 91914 SMX X1100, ERG#133 LX36 Phone: 619-671-0415 EPA: CAR000 66 3 l JS OHao toEZ4O "ot?, oa 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper sh pping name,and are classified,packaged, marked and labeled/placarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify,that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. GeneratoeslOfferor's Printed/Typed Name Signatur'� _ Month Day Year S k F6 8 2s 16.International Shipments El . ErImport to U.S. Xxport from U.S. Port of entrylexit: A-� Irk ? Transporter signature(for exports only): -c-y ke Date leaving U.S.: r 2If 20 2 �W 17.Transporter Acknowledgment of Receipt of Materials w Transporter 1 Printed/Typed Name Signature Month Day Year M Transporter 2 Printed/Typed Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 181b.Alternate Facility(or Generator) U.S.EPA ID Number Z3 Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1• 1406 2' a61 3' HOI 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Prinledfryped Name Signature MonthDay Year Q 2t 2j' EPA Form 8700-22(Rev.12-17) Previou editions are ol�ftl DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM