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Please print or type. Form Approved. 0MB No. 2050-0039 <br /> UNIFORM HAZARDOUS ) Generater ID Number 2. Page 1 of 3. Emergency Response Phone d. Manifest Tracking Number <br /> WASTE MANIFEST CALF 012285151 FLE <br /> 5. Generators Name and Mailing Address Generators Site Address (ifdifferent1 -888-7857225 than mailing address) <br /> Dragon ESP LTD <br /> 15700 McKinley AVei sherri. hetheal@modernusa. com <br /> Generator's Bone: 96'W <br /> FB.91 25 <br /> 6, Transporter 1 Company Name U.S. EPA ID Number <br /> Advanced Chemical Transport Inc./DBA ACTENVIRO CAR0OM70W <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> YUelJ0r 6 v, Mc1559737 <br /> e. Designated Facility Name and Site Address U.S. EPA ID Number <br /> Advenced Chemical Treatment <br /> 3133 Edith Blvd NE NMD002208627 <br /> Albuquerque, NM 87107 <br /> Facility's Phone: j('3 �rj`�2e <br /> ga, 9b. U.S. DOT Deschption (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit <br /> HM and Packing Group (if any)) - No. Type Quantity WtNol. 13. Waste Codes <br /> K 1UN1325,X ( Waste Flammable solids, organic, n.os. , ( DM � , ( P D0D1 0035 F <br /> ACETONE, METHANOL), 4. 1 , PGR 1 � `// <br /> Ulu 2 FOW F0D6 352 <br /> w <br /> cD <br /> 3. <br /> I <br /> 4. <br /> n <br /> f <br /> 14. special Handling metruoGons and Adahional information Pelf Number 1 <br /> r a2s Coctmlent # D107978 <br /> 14 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contentsofconsignment are fully and accurately described above by the proper shipping name, and are classTed, packaged, <br /> marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and material governmental regulations. If export shipment and I am the Primary <br /> Exporter, l 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 generator) or (b) (if I am a small quantity generator) is true. <br /> Generator's/Offerors Printedrivited Name - Signature <--� <br /> Monts - ay. Year <br /> 16, Inter tional Shipments / c Gf <br /> ❑Z Impart to U.S. ❑ Export from U.S. Port ofentrylexit: . _ <br /> Transporter signature exports only). Date leaving U.S..- <br /> 1 T. <br /> .S.:17. Transporter Acknowledgment of Receipt of Materials <br /> Transporter Pri//nte��tl?�ypeaName Signature NY <br /> Year <br /> o. <br /> z TransPorter2Prnted/Ty edNameVear <br /> 18. Discrepancy � � <br /> 18a. Discrepancy Indication Space ❑ Quantity ❑ T e <br /> YP Residue ❑ Partial Rejection ❑ Full Refection <br /> 186. Alternate Facility (or Generator) Reference Number:tor) - U.S. EPAIDPNumber <br /> U <br /> LL Faciliti Phone: <br /> w 18c. Signature otAltemam Facility (or Generator) Month Day Year <br /> Q <br /> Z <br /> w19. Hazardous Waste .Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal,, and recycling systems) <br /> 20. Designated Fac' ity Omer or Operator. Certification of receipt of hazardous materials covered by the manifest except as nobtlimulteasil 8a ) J <br /> PrinteuIydp d. m Signature./ <br /> EPA Form 8700-22 (Rev.. 12-17) Previous editions are obsolete. 1L ` DESIGNATED'FACILITY TO GENERATOR <br />