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Please print or type. Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number <br /> WASTE MANIFEST C,AL0002884W 1 1 .88!;7$57225 012285112 FLE <br /> 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) <br /> Dral ESP LTG <br /> 15700 McKinleeyy Awnue sherri. hethea@modernusa. com <br /> Lathrop. CA 95330 <br /> Generators Phone: 20125 <br /> 6. Transporter t Com any Name U.S. EPA ID Number <br /> Adkanced Sari Transport IPZ./DBA ACIENVIRO CAR000070540 <br /> 7..Tiansgor7er2Corjq,ny Name U.S. EPA ID Number <br /> Y R e 3 %eCCVPr, vVster l; Inc !^AROOOS75122 <br /> .. <br /> 8. Designated Facility Name and Site Address U.S. EPA ID Number <br /> Yuma YES I - <br /> 2730 E. 13th St jAIR000515924 <br /> Y uni AZ 353W <br /> Facility's Phone: 928-344-9d26 <br /> gra, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit <br /> HM and Packing Group (if ani 13. Waste Codes <br /> No. Typo Quantity Wt.Nol. <br /> I Non - 'CRA Hazardous Waste Liquid (Oil, Water) TP o <br /> 222 <br /> o / <br /> w <br /> z 2. <br /> w <br /> f'J <br /> 3. <br /> 4. <br /> I <br /> 14. Special Handling Instructions and Additional Information Prged INIurnbw 171512 Dcocuhm ilt # <br /> 1 ) 1311702 DRY- _ - <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare thatthe contents of this consignmentarefully and accurately described above by the proper shipping name, and areclassified, packaged, <br /> 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 <br /> Exporter, I 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) (HI am a small quantity generator) is true. <br /> Generators/Offerors PrintedF-yped Name Signature Month Day Year <br /> 16. Intemalional Shipments <br /> r- ❑ Impon to U.S. ❑ Exportfrom U.S. Port of entry/exit <br /> K Transporter signature (for exports only): Date leaving U.S.: <br /> U11 <br /> 17. Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Pantedfryeed Name Signature Month Day Year <br /> z Transporter 2 Pnnted/Typed Name "" Signature Month Day Year <br /> r- <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space ❑ quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> F 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> U <br /> LL Facility's Phone: <br /> w 1So. Signature ofAltemate Facility (or Generator) Month Day Year <br /> a <br /> z <br /> h19. Hazardous Waste Repel Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 0 1 . 2. 3. 4. <br /> 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pnntedrfyped Name Signature Month Day Year <br /> EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />