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Please print or type. - Form Approved. OMB No, 2050-00: UNIFORM HAZARDOUS 1 1 . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Trucking Number WASTE MANIFEST CAL0002&3489 1 1 -888-795-72 O 25 12128 5 5 2 F L E 5, Generators Name and Mailing Address Generator's Site Address (if different than mailing address) DMpm ESP LTD 15t57M McKinley Avenue shi hethea(Drnodernuva. com � i CA 953K Generator's Phone: 201:-358-9125 6. Transporter 1 Company Name U.S. EPA ID Number Ackar:ced Chemical T'ramfxxt Iris,/DBA A:,TFNVIRO CARODIXIM40 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number US Ecology Nevada Inc NVT33OO1CNJOG PO Bax 578, FIVW 5L4411 Miles S Beatty Featty, IJV 800M Facility's Phone: 775-553?�X3 gra 91b. 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 (if any)) No. Type Quantity WtJvp. be 1 NA3077, f lazarr_ious Wasile Solids, N. O.S. (Barium) , n, pClfi CF / P C:GOS 181 00051 Y - z 2.NA3077 , Hazardous waste, solid, n.o.s. (CHROMIUM, 17.307 0011 18 T SILVERI, 9 , Pf�ii' DAA P 3. 4. 14. Special Handling Instructions and Adtlilional Information / _ eQ fAxrmer 172W isxurnarTi # D20797J 2) ER IP ' JC JRU t *Vj, 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 EPAAcknowledgment of Consent. I certify that the waste minimization statement identfied in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) if I am a small quantity generator) is true. Generators/Offerors Printed/Typed Name Signature Month Day :- Year � 16. International Shipments p_ ❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: 9 Transportersignature (for exports only): Date leaving U.S.: ¢ 17. Transporter Acknowledgment of Receipt of Materials. ILL! Transporter Printed/Typed Name Signature Month Day Year QI ransporter 2 Printed/Typed Name Signature Month D'ay Year F 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity 1-1 Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: F 18b. Alternate Facility (or Generator) U.S. EPA ID Number U Facility's Phone: w 18c. Signature of Alternate Facility (or Generator) Month Day Yea Q Z 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 except as noted in Item lee PrintetlRypetl Name Signature Month Day Year EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. GENERATOR'S INITIAL COP