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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.GeneratorlD Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAC003018492 1 888-785-7225 012794978FLE 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) CALAVERAS MATERIAS INC 11TH STREET AND BIRD AVENUE 7675 N.INGRAM AVE.STE.104 TRACY CA,95304 FRESNO CA,93711 Generator's Phone: 209-390407 6. Transporter Company Name U.S.EPA ID Number ADVANCED CHEMICAL TRANSPORT INC.DBA ACTENVIRO CAR000070540 7.Transporter 2 Company Name U.S.EPA ID Number WORLDWIDE RECOVERY SYSTEM INC CAR000175422 8.Designated Facility Name and Site Address U.S.EPA ID Number YUMA YES WASTE TRANSFER FACILITY AZR000515924 2730 E 13TH ST YUMA AZ,85365-1901 Facility's Phone: 623-326-964 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./Vol. 1.NON-RCRA HAZARDOUS WASTE,SOLID(OILY DEBRIS,ABSORBENT) O 1 CF 1560 P Of 52 W 2.NON-RCRA HAZARDOUS WASTE,LIQUID(OILY DEBRIS,ABSORBENT) LU 0 DF 226 P 52 3, 4, 14.Special Handling Instructions and Additional Information 1)1913306 CAY-001 1XCYB PROJECT NUMBER 208181 DOCUMENT#:D250491 2)1913306 CAY0002 WO#540553 1X55 OH;Line 1:Line 2: 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, 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. eeto s/ eros Printe/Type Name Signature on ay Year JOHN GOBHAN JOHN GOBHAN 07 01 2019 1 16.International Shipments F Import to U.S ❑Export from U.S. Port of entry/exit: Transporter signature for exports only): Date leaving U.S.: U-1 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year aO MARTIN HERNANDEZ MARTIN HERNANDEZ 07 01 2019 U) Transporter 2 Pd ed/ryped Name Signature MOM Uay Year Q PAUL D MACFARLAND JR PAUL D MACFARLAND JR 07 08 2019 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: r 18b.Alternate Facility(or Generator) U.S.EPA ID Number 3 U LL Facility's Phone: In 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. 3. 4. H141 H141 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year PATRICIA ALVAREZ PATRICIA ALVAREZ 07 15 2019 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM