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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 CAL000432921 1 800-326-1221 020606820JJK <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) T <br /> PACIFIC AG RENTALS LLC <br /> 3540 CARPENTER RD <br /> STOCKTON CA,95215 <br /> Generator's Phone: 831-970-4564 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> CLEANTECH ENVIROMENTAL CAL000399638 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> HERITAGE TRANSPORT LLC IND058484114 <br /> 8.Designated Facility Name and Site Address U.S,EPA ID Number <br /> HERITAGE ENVIRONMENTAL SERVICES LLC AZD081705402 <br /> 284 284 EAST STOREY ROAD <br /> COOLIDGE AZ,85128-9205 <br /> Facilitys Phone: 317-486-2778 <br /> 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt,Nol. 13.Waste Codes <br /> 1.RQ,UN1950,WASTEAEROSOLS,FLAMMABLE,N.O.S.,2.1,(PAINT,LUBRICANTS), D001 <br /> 0 ` (D001),ERG#126 1 DM 100 P <br /> /X` 331 <br /> ILI <br /> Z 12. <br /> W <br /> 0 <br /> 3. <br /> I I <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> Document::11708401;Line 1:Profile#:164429-1;DocuLine:17536904; <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 international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terns of the attached EPAAcknowledgment of Consent. <br /> 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 We. <br /> Generator's/Offerors Pdnted/ryped Name signature Month Day ear <br /> Y Y 04 1 24 1 2019 <br /> 16.International Shipments <br /> f- Import to U.S ❑Export from U.S. Port of entry/exit: <br /> z <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.TransporterAcknowledgmentofReceiptofMaterials <br /> Transporter 1 Pdnted/ryped Name Signature on Day ear <br /> a JOHN ARILEY I JOHN ARILEY I 04 I 24 12019 <br /> Z Transporter 2 Pdnted/ryped Name Signature Month Day Year <br /> W REYES MEZA REYES MEZA 05 03 2019 <br /> 18.Discrepancy ��LL <br /> 18a.Discrepancy Indication Space Flquantity [: ype ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> u Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 05 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1. 2. 3. 4. <br /> H141 <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pdnted/ryped Name Signature Month Day Year <br /> DARCIE GATES DARCIE GATES 05 13 2019 <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />