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Please print or type. Form Approved.OMB No.20500039 <br /> UNIFORM HAZARDOUS F1.GAn,,atorlDNuni 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST 000181286 1 1-888-785-7225 012285180 FLE <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Advanced Industrial Coatings <br /> 950 Industrial Dr <br /> Stockton, CA 95206 <br /> Generator's Phone: 209-234-2700 <br /> 6.Transporter i Company Name U.S.EPA 10 Number <br /> Advanced Chemical Transport Inc./DBA ACTENVIRO CAR000070540 <br /> 7 Transporter 2 Cam any Name U.S.EPA ID Number <br /> Worldwide Corn <br /> System, Inc CAR000175422 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Yuma YES, LLC <br /> 2730 E. 1 Sth St AZRW0515924 <br /> Yuma, AZ 85365 <br /> Facility's Phone: 928-344-9828 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers It.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity W1.1V0I, <br /> 1 an A HaZard.011S Waste Solid(Dried Paint) t CIF ! p 291 <br /> J ,/J <br /> 0 <br /> z z <br /> c� <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional lnfor ation Project Number 173827 Document#. D208413 <br /> 1) 1811813 ADY- <br /> C7 # -_ <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 iabeledlplacarded,and are in all respects in proper condition for transport according to applicable inlernationaland national governmental regulations.It 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 gonerator)or(b)(if l amA small quantity generator)is true. <br /> Generator'sl0heror's PrintedfTyped NameSignatu Month D y Year <br /> 1 § E�li�61 <br /> 16.In emational Shipments <br /> H ❑Import to U.S. ❑Export from U.S. Part of entrylexit: <br /> z Transporter signature(for exports only): Date leav,ng U.S <br /> = 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Transporter 1 PrintedlTy ed Name Sig natureon Year <br /> 0. L� <br /> ra a fe pe Nsme rJ Si lure�i7 Mon4th Day Year <br /> 18.Discrepancy <br /> I Be,Discrepancy Indication Space ❑ quantity El <br /> Type ❑Residue Partial Rejection ❑Futi Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> LU 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z1 <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 01 � 2. 3. 4. <br /> 20.Designated Facility Owner or operator:Certification of receipt of hazardous materials covered by the manila except as noted in Item 1 Be <br /> PrintedlType me Sig afar Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. -U, AT FACILITY't'0 TA's e•MANIFEST SYSTEM <br />