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Please print or type., Form Approved. MB No.2050-0039 kftiRM HAZARDOUS 1.Generator ID Number 2.Page 1 of3.Emergency Response Phone 4. if t c ' U e WASTE MANIFEST CAR0001 BOB44 2 888.785-7225 I T TO 4 8 3 5 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Aisin EleotroNcs Inc 199 Frank WeSt Stockton, CA 95206 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number Adtisnced Cttam1cal Transport Inc./DBA ACToroo CAR000070540 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 PBOX�B HWY 9.�i,11 MileS S Beatty �1= sawFacility's Phone: 7_6- 2= ga. 9b.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 Wt.Nol. Iz1 UN3266,Waste Corrosive liquid basic,inorganic,n.o.s. o 1 D006 (Sodinnn Hydroxide,Potassium Hydroxide),8,PGII � �. 1/17s- P :. 121 D002 W2UN3266.Waste Corrosive Nguid,basic,inorganic,nus 121 DO02 , " X (Sodium Hydroxide,Potassium Hydroxide),8,PGR r P D007 DORS X 3 A3077,Hazardous waste,solid,n.o.s.(Lead),9,PGM [ P 181 D00B 4Non-RCRA Hazardous Waste Liquid(SMca.,Acrylate 343[ Oligomer) '2 DV 47� P 14.Special Handling Instructions and Additional Information ;Pn4oct Nun*& . ,W lbcment it M69MS 1)ERG9154; 070137711-8244 AllJ- 2X q C 070128301-15713 ALI- a{X C 2)ERG#154; 070137711.8244 AIS '3K 3,r) C 070131570-21877 AK,1 _11 /4,07 (45-07-00&) 15. GEN ERATOR'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.. certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I a,nnjoaii quantity generator)is true. Generator's/Offeror's P'ntedfry d Name / Signature Month Day Year ae Grave/'.. rS 16.International Shipments F_ ❑Import to U.S. ❑Export from U.S. Port of entry/exit: z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LLI Transporter Pin /Typed Name Signature Month Day Year CL z Transporter 2 Printed/Typed Name Signature Month Day Year rr 18.Discrepancy 18a.Discrepancy Indication Space- ❑ Quantity ❑TypEl e yp ❑ResidueRejection � Partial Rejection ❑Full Manifest Reference Number: F 18b.Alternate Facility(or Generator) U.S.EPA ID Number _J I V LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z S219.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1 l � 2. 3. PAS 1 4. 0 20.Designated Facility Owner or Operator:Certification of ipt of haza ous materials covered by the manifest except as noted in Item 18a P edlTy ed IN _$ t Signat2k) M th Q ��r, EPA Foam 8700-22(Rev.1(/2„-17) Previous editions are obsolete. DESIGNATED FACILITYTO GENERATOR