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Please print or type. Farm Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2.Page t of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> ` <br /> WASTE MANIFEST � 012283649 F L E <br /> { 5.Generators Name and Mailirtt Address Generator's Site Address(if different than mailing address) <br /> It Thatcher Comrany of California <br /> 1010 Industrial [Dove <br /> Stockton. CA 95206 <br /> Generators Phone: <br /> 6.Transporter 1 CoRf�ar:y Name <br /> U.S..EPA lD Number <br /> Advanced Chemical Transport Inc./DBA ACTENVIRC CAR000070543 <br /> 7.Transporter 2 CompanyName U.S.EPA 10 Number <br /> '�` orldWde eovefy, System, ire CAR0001 542 <br /> r 8.Designated Facility Name and Site Address US EPA ID Number <br /> Yuma`CES, LLC <br /> N30 E. 13th St A-7ROD0515924 <br /> Yuma, AZ 3536 <br /> Facility's Phone: & `g <br /> ga. 9b.U,S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Umt <br /> tiM and Parking Group(E any)) 13 Waste Codes <br /> foo. Type Quantity Wt,fto. <br /> 1Ni-jr, RC RA fLiza rc3.u b 11'Le c Sold(Pii,4ch Filio--t.--,j <br /> — <br /> ;E � <br /> I 2. <br /> LU <br /> ca <br /> 3 <br /> I <br /> E 3. I <br /> 14.Special Handling Instructions and Additional information r Hy l nihe4' � aDocument 1912 <br /> 1) 1511471 THY--QA QQ6 GSb <br /> i <br /> 15. GENERATOR'WOFFEROR'S GERTIFICA'nON: 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 laWedlplacarded,and are in all respects in proper condition for transport according to appiieabde intemationat mid national governmental regulations.9r'export shipment and I am the Primary <br /> I Exporter,I car*that the contents of this eonsgnment conform to the terms of the attached EPAAcknovaledgment of Consent. <br /> I certify that fete waste minimization statement identified in 40 CFR 262.27(x}(if I am a large quantity generator)or(b)lift am a small quantity generator)is true- <br /> r Genorato srOffieror's Printed`typed Name Signature Month Day year <br /> a 10.lnt matonalShipments �--1 i <br /> P- L-1 Import to U. . Export from U S Port of entry°exdf -- <br /> Transporter signature(far exports only): Date leaving U S. <br /> W IT TransporWAcknuwledgment of Receipt of Materials <br /> er 1 P:nt Name Si naEure <br /> f g Month Day Year <br /> 1 <br /> Transporter 2 ntedf yp?d Nara 9ttmure Month Day Year <br /> sglu <br /> 19.Cisccepancy <br /> t3z.r s re _:y rn s<.;r Spa e ❑Type <br /> F1Pai4ial Re)ection PuFullRe`fe <br /> ctwn <br /> Manifest Reference Ntlrtltret <br /> #Stn.Affemate Facikry(ort Gonerator) U.$.EPA 1D Number <br /> to <br /> F.di ty's Ph.: <br /> w 18c.Signature of Alternate Facllily for Generator; hrtonfh Day Year <br /> +S <br /> rrnn 19.Hazardous Waste Report Management Methad Codes(i.e.,codes for hazardous waste treatment,disposal.and recycling systems) <br /> uu <br /> 14. � <br /> r <br /> 20,Designated Faclity Owner or Operator Certification of reoelpt of hazardous materials covered by the manifest except as rx]ted in tte <br /> Printedyp Name Signature Month Day Year <br /> I <br /> EPA Form Foo- iRev. - F! Previcau ed8tions ar orb otete. f l ? ACfI[TY Tt7 ESA's--MANIFEST SYSTEM <br />