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Please print or type.(Farm designed for use on elite(12-pitch)typewriter,) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number y WASTE MANIFEST CALL , J J K 5.Generators Name and Mailing Address Generators Site Atltlress(if different Man mailing address) TECOF.- A-LOUISEAVE 2050 E LC U:3E A'JE LATHROP CA 95330 Generator's Phone: 'r'" R r" 1...0 6.Transporter 1 Company Name U.S.EPA ID Number SERV;CF:? CAD02C 7703 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number 6500,US HIGHWAY 90 YUMA AZ 85365 AZR00052 i Faciff 's Phone: go, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. TypeJi Quantity Wt.A/c I. 0 1.NON-RCRA HAZARDOUS WASTE.SOLID(OILY SOLID) ag z 2. w c� 3. 4. 14.Special Handling Instructions and Additional Informal EMERGENCY CONTACT:CHEMTREC 1-800.424-9300 WOES TERMINAL:CERES CS NAERGM 9B1:171 PROFILE N 981: 162623NRSTEC605 OILY SOLID *' *'APPROPRIATE PPE EQUIPMENT 15. GENERATOR'S/OFFEROR'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 forms of the attached EPA Acknowledgment of Consent. I certify that the waste mininnizatioill,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. Generators/Offerors Prnted/fyped Nam Signature - or Year /1 /- 11- - r- J 16.International Shipments Import to U.S. ❑Export from .S. - Por ofentry/exit Transporter signature(for exports only): Date leaving U.S.: all 17.TransporterAcknowledgment of Receipt of Materials Transporter 1 Pomecirlyped Name/--f (may/ySignature Month Day Year 2 Transporter 2 Printed/Typed Name Signature Q .� ' @ Month Day Year Q JA t18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type El Residue ❑Parial Rejection ❑Full Rejection Manifdsf Rdference Number. 181h.Alternate Facility(or Generator) U.S.EPA ID Number J V LL Facility's Phone: w Ise.Signature of Alternate Facility(ar Generator) Month Day Year d 2 y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 2. 3. 4. 1 20 Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item Ise Printed/Fyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR