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Please print or type. Form Approved.OMB No.2050-0039 U <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manffest Tracking Number <br /> WASTE MANIFEST CAL000432921 1 800-326-1221 020022994JJK <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> PACIFIC AG RENTALS LLC <br /> 3540 CARPENTER RD T <br /> STOCKTON CA,95215 <br /> Generator's Phone: 831-970-4564 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> AGRITEC INT DBA CLEANTECH ENVIRONMENTAL CAL000330453 ■�.Y 1. <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 x <br /> HERITAGE ENVIRONMENTAL SERVICES LLC AZD081705402 <br /> 284 284 EAST STOREY ROAD <br /> COOLIDGE AZ,85128-9205 <br /> Facility's 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 /> 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1,RQ,UN1950,WASTEAEROSOLS,FLAMMABLE,N.O.S.,2.1,(PAINT,LUBRICANTS), D001 <br /> 0 ` / (D001),ERG#126 1 DM 60 P <br /> 4 x _....-1331 <br /> W 2. 1 <br /> 3. <br /> i <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> Document::11957834;Line 1:Profile#:164429-1;Docul-ine:17901793; <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 labeledlplacerded,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 terms of the attached EPA Acknowledgment 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)(ff I am a small quantity generator)is true. <br /> Generatoris/Offeroris Pdnted/Typed Name bignature Morith Day ear <br /> CLAYCEE C FITCH JR CLAYCEE C FITCH JR 06 1 26 1 2019 <br /> 16.International Shipments <br /> F- Import to US ❑Export from U.S. Port of entrylexit: <br /> Transporter signature for exports only): Date leaving U.S.: <br /> LU 17.TransporterAcknowWgmentofReceiptofMaterials <br /> � Transporter 1 Printedfryped Name Signature on Day ear <br /> CC) JOHN HICKS JOHN HICKS I 06 I 26 12019 <br /> U) <br /> Transporter Printedflyped Name Signature Month Day Year <br /> p. RAYMUNDO GUTIERREZ RAYMUNDO GUTIERREZ 07 05 2019 <br /> t-- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity [:type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> LL Facilitys Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> � <br /> 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 /> Printedfryped Name Signature Month Day Year <br /> DARCIE GATES DARCIE GATES 07 11 2019 <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />