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Please rint oriype. Forrn Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Mrf t T Wpg u be d WASTE MANIFEST CALOW2864M 1 888-•78&722r5 0 14 "r �4 3 F L E 5.Generator's Name and Mailing Address Generator's Site Address(If different than rualling address) Dram ESP LTD 157W McKllfoy Menne Lathrop, CA 9M.30 Generator's Plions: 208• rs"l 25 6.Transporter 1 ConyNatne U.S.EPA ID Number Ad diced=lcal Transport Inc./DBA ACTwwro CAROOM70540 7-Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Advanced Chemical Theatment tJMD00��7 8133 Edith MW NE WVwPhone: 6 M?9-1? Faalllt)r'S Phone: 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. 1.1-Et l UN tZ53,waste 11ahH Relate(]Material 3,J-2GH,(MR)1) ON! P D001 F002 I'MI F665 MM) 2184 Z 2. LU C7 4 14.Special Handling Instructions and Additional Information Pfniftt NIURT er 16;18&)4 uccu en a., D31%42 1)EIIR01*128; ACT137M DPA--LJ' - 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 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)(ifl am a small quantity generator)is true. Generatodf ror's Printed ed Name i Signature Month Day Year 1 + J 16.International Shipments ` F ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ?I Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature f Month Day Year QTransporter 2 Printed/Typed Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity El Type El Residue El Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U-S.EPA ID Number J U LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C3 1 2 3- 14L 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