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Please print or type. Foran Approved.DMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number- WASTE MANIFEST t +.ate �13T 3f3 ] C' '� ":= JtJK a, 5.Generators N ame and Mailing Address Generator's Site Address(if different than mailing address) -4 B C J ra aissio r - hic. 1.93 S Union Rd. Ma1'iteca, A 93337 Generators Phone: 209-918-2650 6.Transporter 1 Company Name U.S.EPA ID Number SAC,IRAV1ENT0 WASTE SIL a3 912 7.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facliity Name and Situ Address U.S.EPA ID Number US Highway 915 , Yuma, F r-izon a 85365 Facility's Phone: :128'"'642^8938 r,4tura ga. 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.Ncl. 1. NON—CRA HAZARDOUS WASTE SOLIDS u� (Di?s Solids) z 2. ru 3. 4. 14.Special Handling Instructions and Additional Infdrmation L� AND USE Fi k, 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,arta are classified,packaged, marked and labeledlpacarded,and are in all respects in proper condition for transport according to applicable internal 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 he. Generatoi dOi Printedffyped Name Signature Month Day Year J 116.1internatiDnal Shipmen#s ❑Import to U.S. ❑Export from U.S. Port of entryexit: ? Transporter signature(for exports only): Date leaving U.S.: w 17.TransporterAcknowledgment of Receipt of Materials Transporter 1 Printed!Typed Name Signature E,onth Day Year Me Hernandez z Transporter 2 PrintediTyped Name ^� Signature Month Day Year 18.Discrepancy g 18a.Discrepancy Indication Space ❑ quantif ❑T ❑Residue y Type ❑Partial Rejection ❑Fuli Rejection Manifest Reference Number: 186,Alternate Facility(or Generator) U.S.EPA ID Number J_ U Facility's Phone: L 18c.Signature of Alternate Facility(or Generator) Month Day Year Z _ 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 2. 3. 4. 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a Printed'Typed Name 1 z Signature }' Month Day ' Year 4 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. �. DESIGNATED FACILITY TO GENERATOR