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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. Manifest Tracking Number WASTE MANIFEST - „jt(j q 1 88&785-7225 0122836 , 4 FLE 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) Dragon ESP i 5700 McKin�iee�v �A�.�nue sherrl. hethea@rnociernusa com-r Lathrop, CA 95331 Generators Phone: 209.85E 6. Transporter 1 Company Name U.S. EPA ID Number Adtienced ( tlenroc:z :Daort Inc.1DBA ACIENVIRO CAR^WO070540 7. Transporter Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number 6133 Edith Btvd NE NMCm(Y2208327 Altxtquerque, NM 87107 Facility's Phone: 505-349-5220 9, go. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit 13, Waste Codes HM and Packing Group Cif any)) No. Type Quantity Wt.Nol. N 1325, Waste F ammable solids, organic, n,0.s. o DOW FW4 (ACETONE . METHANOI ), 4A , PGE 1 d P 000i �aFW3 F006 352 z 2. w CO 3. 4. 74. Special Handling Instructors and Additional Information pric lectNJIi 1�3Sm Dix # d21�3 1 ) ERG#133: ACT3Z220 O17A \J}' 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, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicableinternational and national governmental regulations. If export shipment and am the Pnmary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified In 40 CFR 262.27(a) (rf I am a large quantity generator) or (b) lift am a small quantity generator) is true. Generators/Offeror's Pante IfTyped Name Signature Month Day Year t 16. Imemational Shipments % p ❑ Impor U.S. ❑ Export from U.S. Port of entry/exit ? Transporter signature (for exports only): Date leaving U.S.: Di w 17. Transporter Acknowledgment of Receipt of Materials K Transporter 1 Printed/ryped Name Signature of ' Month Day Yew y Qz Transporter2 Pdnted/Typed Name Signature Month • Day Year K r— 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity Type ❑ ❑ Partial Rejection ❑ Full Rejection ❑ T a Resitlue 18h. Alternate Facility Manifest Reference Number: r_ ty (or Generator) U.S. EPA ID Number U LL Facility's Phone: w 18c. Signature of Alternate Faciiity (or Generator) Month Day Year Q Z d—i 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal and recycling systems) 0 1 2. 3. 4. 20, Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest eexmpt as noted in Item 18a Pnnted/Typed Name Signature Month Day Year EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY