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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Farm Approved.0i No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST 7$ 1 G B F- 5 Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) .450CIATED TRACTOR SERVICE. INC f 323 W CHAR 1'ER WAY Generator's Phone: 014,CA $5295 6-Transporter 1 Company Name U.S.EPA ID Number T Transporter 2 Company Name U.S.EPA ID Number S.Designated Facility Name and Site Address U.S.EPA ID Number ,!0tK>I'4C.Wli-All DR.EAb i FERNLEY, 1W 8"08 Facility's Phone: ga 9h.I-)S.DOT Description(including Proper Shipping Name,Hazard Class.ID Number, 10,Containers 11.Total 12.Unit FiM and Packing Group(if any)) No, Type Quantity WI.Nol. 3.Waste Codes t rY 14(-4 -R6RA H,1kZ.Attl".0US WASTE 801.-i•- 111i GAIL &GREA`IF ur Z 2. W C7 3 4. 14,Special Handling Instructions and Additional Information 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 labeiedlplacarded,and are in all respects in proper condition for transport according to applicable internalional 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 EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(i(if I am a small quantity generator)is true. Generator'slOfferora PriniecITyped Name Signature Month Day Year J 16.Intematlonal Shipments F— ❑Import to U.S ❑Export from U.S Port of entry/exit: Z Transporter signature(for exports only): Dale leaving U.S,: w 17.TmnsporterAcknowledgment of Receipt of Materials OTransporter 1 PrintodlTyped Name Signature Month Day Year d Z Transporter2 Printedlfyped Name Signature Month Day Year F- 18.Discrepancy 18a.Discrepancy Indication Space. Residue Partial Rejection ��pvopriate perm ) ❑ ❑ ❑Full Rejection will accept the waste Manifest Reference Number: 18b,Alternate Facility(or Generatoi).: shiz� U S EPA 16 Number J U �a+ Facility's Phone: w 18c.Signature of Alternate Facility(or Generator( Month Day Year a Z 05 11 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1- 2. 3. 4, 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. J 1 DI1GNATED FACILITY TO GENERATOR