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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.M ifit T g�lu be WASTEMANIFEST CALOCO�$9 I 9 SM765-7225 11 44 FLE ri.6 rinralnr's No and�nlling Address Gmrtnralor's Site Address(if different than mailing address) P LID 15 McK" Avenue bihirop, CA Generator's Phone: �r 025 13.)=,r1 s rm;1 an I Transport Inc./DBA ACTerivr�a U.5 EPAIONumber CAMIDIX70W 7.Transporter 2 Company Name U.S.EPA ID Number 8.Desig�aled Facility NaMe and SRO Address U.S.EPA ID Number US 9colc�gy 111exe& kic NVT3300t� PO Box 578 A.11 Miles S Beatty amitty, NV�3 Facility's Phone: 7*6153-203 9a, 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. X 1.rmnaui r,riazamous waste,sonu,n.o.s_tt luomntm),u,ruua OM P 181 11007 0 LA _1 y w w 2. 3 4. ;cial Handling Instructions and Additional Information ir-newl NtffnW 1ti i&W LkXA nfjnr S' U31HtiO3 1)EIRG#'!71; 07012M3,4 3302 DFO 15. GENERATOR'S/OFFEROR'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. I certify that the waste minimization statement identified in 40 CFR 282:27(a)(if I am a large quantity generator)or(b)(ill am a small quarilily generator)is true. Gvr�eralci'slUiferors Printed/Typed Name + Slgpature Month bay Year 1ij 4 r,' J 16 Interna conal Ship is ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedlTyped Name Signature Month Day Year J.t Transpwter 2 PrintodlTyped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space Quantity L1 Type L1 Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ L) I 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, 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 Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY