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Please print or type. Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifetst Tracking Number WASTES Name and _ ,,ArZS64&0 'I L"S-M&7225 VA2836 j 6) FLE 5. Generators Name and Mailing Atldress Drawn ESP LTE? Generator's Site Address (if different than mailing address) 1 .5100 A�vMcKin�lMcKinley � enue Shell. . hethea@jnoderrrusa. rom Lathrop. CA 95330 Generators Phone: 209-85&9125 6. Tm $porter 1 Com any Name Ac�enced GFhemical Transport inc./DBA ACU.S. EPA ID Number TENVIRO CAPQ0G�7�5g0 7. Transporter 2 Company Name U.S. EPA ID Number B. Designated Facility Name and Site Address U.S. EPA ID Number US Ecol Y Nevada, hC PO Bax 6, r{m 95, 11 Miles S Beatty NVT330010000 ueatty, Facility's Phone: �553"2203 9a. 91d. U.S. DOT Description (including Proper Shipping Name, Hazard Class, 10 Number, 10. Containers 11 . Total 12. Unit HM and Packing Group (if any)) No. Type Quantity Wt. Unit 13. Waste. Codes 1 .. ' : ,+tr l tta.zarctozs w2sle, so id, n.us. (Lhromiumj. , YG lq DM P 181 0007 rz 2. ,sI . 1 ZEk ous VVaste SoUCJS' t . .5. 9. 181 x {0005} _ DM P 3.1 ous s , n.us. Itr rural D007 D011 181 SILVER) , 9 , PGRI 0M Q 4. 14. Special HarMling lnstmcdons. and Adtli6onal Information urOJBCyr fV.671bBf�1 17DInrw1ert # D2Wr 1 ) ER=71 : 070128303-13302 DRi1- f r l� _ � ( t ---; �.-�t) ERGp171: 070128303,6" 0 -- j "'12830 701283D3690D0 -- - - 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, pwkaged, 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 Exporter, I certify that the contents of this consignment conform to the tennis 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) (AI am a small quandty generator) is true. Generators/Offeror'sPrintedrryped Name Signature Month Day Year J 16. International Shipments f F- ❑ Import to U.S. L1 Exact from us, Port of entry/exit ? Transporter signature (for exports only): Date leaving U.S.: of w 17. Transporter Acknowledgment of Receipt of Materials t2 Transported Printed/Typed Name Signature o Month Day Year a _ ZW K Trans porter 2PrintedlTyped Name Sign ature Mont Day Year 18. Discrepancy 18a. Discrepancy Indication Space ❑ quantity ❑ Type ❑ Residue ❑ Partial Rejection El Full Rejection 18b. Alternate Facility (or Generator) Manifest Reference Number. J U.S. EPA ID Number U ua- Facility's Phone: w 18c. Signature ofAlternme Facility (or Generator) Month Day Year a z W 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment disposal, and recycling systems) 0 1 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by Ne Manifest except as noted in Item 18a PnntewIyped Name Signature Month Day Year EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY