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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,bifIt Trac 'n u e WASTE MANIFEST 'l�.�s �@OB44 �t38-78�-7 1 4833 FL E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) AISIn Electmirlics klc 199 FrW*West Stoeieteln, Cly 95206 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number AdMnced.Chemical Transport kr,./DBA ACTM*o CAR000070W 7.Transporter 2 Company Name U.S.EPA ID Number ti*Adwide Recolsly Systeme Inc CAF%VM175422 8.Designated Facility'Name and Site Address U.S.EPA ID Number Yuma YES LLC 2730 E. 13th St AZ R00O515924 Yuma, AZ 533M Facility's Phone: 928-+344-M8 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity wt./Vol. 13.Waste Codes i iNon-RCRA Hazardous Waste,bqdd,(CorAant, adkeez+e) 135 'Y21137 P W 2 orn-32CRA Hazardous Waste Sdi (04,Solids) f, 25+ 3. 4. I 14.Special Handling Instructions and Additional Information ed(mom 222M t MBSM 1) 176712AIY- 2) 1914M AIY--F--41 T p� 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 intprnatiopaland national govemmental 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 EPAAcknowledgmo 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/Offeror's Printed d Name , Signature Month -Days Year J 16.International Shipmen F— ❑ port to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LU OTransported PnntedlTyped Name u� SignatureA Month Day Year Z Transpp7 r 2 Printed/Typed Name Signal Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection 1 ❑Full Rejection F Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. i f 2. 3 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a a Printed/Typed Name ' Signature Month .Day Year 4--1 U i I if I t EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. D S NATED FACII ITY TO GENERATOR Lj