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Please print or type. Form Approved. OMB No. 2050-OC UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4, Manifest Tracking Number WASTE MANIFEST 2` � �` '' 2 FLE RRFi7 � � J 1 �' :; 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) -hdgOi i CSI L ; L: 15700 MclCinleX Awnue sheen. het±tea nxxiernusa. ctim Lathrop. CA OS 30 Generators Phone: E; 21 - 6. Transporter 1 Company Name U.S. EPA ID Number Advanc = -- . _ moat Transport trio ./DBA .ACTEt f%ARO CARD00070540 7. Transporter 2 Company Name U.S. EPA ID Number 8, Designated Facility Name and Site Address U.S. EPA ID Number US Ecoiopy Nevada, Inc hlVT 30010000 Beatty, N PO Box 576, I tr✓y_ 95, 11 Miles s Beatty V 89003 Facility's Phone: T/5-55S-22M ga. 91b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12Unit13. Waste Codes HM and Packing Group (if any)) No. Type Quantity WtNol. 1 NA3077. Hazaatous waste, solid. n.o.s . (Dust, Chromium) , 9 , CM 0007 181 A PCrlll z 2. Lot 0 3. 4. 14. Special Handling Instructions and Additional information Project Number 1 &.i11-', ikiC;d'(Ylfi'FG /x J.'t6CXJ ? ERCW71 : 070'12{3301-15178 Dli 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 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 terms of the attached EPA Acknowledgment 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) (if I am a small quantity generator) is true. Generator's/Offerors PrimedlTyped Name Signature Month Day Yea; 16. Intematlonal Shipments F ❑ Import to U.S. ❑ Export from U.S. Port of entrylexit: ? Transporter signature (for exports only): Date leaving U.S.: ci 111.1 17. Transporter Acknowledgment of Receipt of Materials K Transporter Printed/Typed Name Signature Month Day Year O a Transporter 2 Printe Irryped Name Signature Month Day Yea; 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity El Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number zi U LL Facility's Phone: w 18c. Signature ofAternate Facility (or Generator) Month Day Yee a z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 3. 4. 20. Designated Facility Owner or Operator, Cedificaton of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Yea; EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. GENERATOR'S INITIAL COF