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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAR000220046 1 909-981-998.3 017231597 FILE <br /> 5 Generator's Name and M__a__ili�ngfl A�ddress Generator's Site Address(if different than mailing address) <br /> CALIFORNIA KWTH CAPE FACILITY (07557) 7707 SOUTH AUSTIN ROA17 <br /> 7707 SOUTH AUSTIN ROAD (attn: M. whistle STOCKTON, CA 95215 (attncvari, whistler) <br /> STOCRTION, CA 95215 <br /> Generators Phone: 900 467-7QQ4 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> INDUSTRIAL WASTE UTILIZATION, INC- CAD980585293 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 6.Designated Facility Name and Site Address U.S.EPA ID Number <br /> AA SYDCOL,LLC <br /> 2264 E. 13th Street <br /> YUMA, AS 85365 <br /> Facility's Phone: 928-703-3679 AERO U 05 203 04 <br /> gra 9b.U.S.DOT Description(inducing Proper Shipping Name,Hazard Class.ID Number. 10 Containers 11,Total 12,Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wffvol. <br /> 1_ on XL;XA 11assarclaci waste 1icjfi (aqueeotucs 331 <br /> rr water base evulsion) <br /> aO / <br /> C 15-5 1 <br /> z 2. onXCRA liclazardiatUts waste solid( of y rags 223 <br /> w <br /> 0 <br /> Gl <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 1) aqueous water base emulsion—L10638—LL1/CHCF 2) oily rags—app$ 510384—SLS <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare 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 Ie ationaland national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I codify that the contents of this consignment conform to the terms of the attached EPAAcknowledgm of Co nt. <br /> I caddy that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity general r(b) m a s II antity generator)is true. <br /> GeneratoeslOfierors PrintedTyped N Sign a Month Day Year <br /> 1p2�L l5�szz�_ <br /> 16.International Shipments <br /> i— <br /> L1 Import to U.S. ❑Export from U.S. Port of entrylexil: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> tr 17.Transporter Acknowledgment of Receiptof Materials <br /> w <br /> K Transporters PdnledlTyped Name Si re Month Day Year <br /> 0M 641M Y <br /> L II <br /> Z Transporter Printed/Typed Name -Signature Month Day Year <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑PartaReaction Full Rejection <br /> Manifest Reference Number. <br /> 181p.Alternate Facility for Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> V—' 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment.disposal.and recycling systems) <br /> UJI <br /> rn <br /> O 1 41 2 • ,w• . I 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as it in Item 18a <br /> Prided/Typed Name Signature Month Day Year <br /> Z Z <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. ESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />