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Please print or type. 4 GENERATOR ,.. I UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1. Generator ID Number <br />CAR000186668 <br />2. Page 1 of <br />1 <br />3 Emergency Response Phone <br />888-785-7225 <br />4. Manifest Tracking Number <br />014706686 FLE <br />Generators Name and Mailing Address Generators Site Address (if different than mailing address) <br />American Biodimel INC DBA Community Fuels <br />809 SNEDEKER AVE STE C <br />STOCKTON, CA 95203 <br />Generators Phone: 2094664823 I <br />Transporter 1 Company Name U S. EPA ID Number <br />Advanced Chemical Transport Inc./DBA ACTenviro CAR000070540 I <br />7Jransporter 2 Company Name US EPA ID Number EninronmentaiManagemerd Tec hnologies CAR000183574 <br />I <br />8. Designated Facility Name and Site Address U S EPA ID Number <br />Ermronmental Waste Solutions <br />31915 Industrial Ln. AZR000520478 <br />Parker South, AZ 85344 <br />Facility's Phone: 877'227-0189 I <br />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 anyl) No Type Quantity Wt Nol <br />1 Non-RCRA Hazardous Waste Solid (Absorbed biodiesel <br />solids) <br />DM P 352 , <br />2Non-R.CRA Hazardous Waste Liquid (Oil) DO P <br />22 1 <br />! I <br />3 <br />• <br />1 <br />i <br />4 <br />1 <br />14 Special Handling Instructions and Additional Information Project Number 272947 Document #: 0330436 <br />EW56053 AME- CI‘ - CIZ:t.9 ( <br />EWS6054 AME-Ok0 - Ok -t_ L. "3 <br />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, arc are classified, 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 lam 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 tam a large quantity generator) or (b) (dl am a small quantity generator) is true. .‘ <br />Generators/Offerors Printed/Typed Name Sig <br />Aii I"140 iliaiii0"/ 4(k.,4),/z/ <br />Month Day Year <br />/ • <br />) 51 2-c-3 <br />g <br />r• -fl 16. International Shipments Import to U.S Export from Port of entry/exit: <br />Transporter signature (for exports only) Date leaving U.S.. TRANSPORTER 1 17 Transporter Acknowkidgment of Receipt of Materials <br />Transporter 1 Printed/Typed Name Signature . Montn Day Year <br />VY\.••(--,‘"1 14,1E-- r)F.,-----S S ,...----2. <br />Transporter 2 PnniediTyped Signa re Month Day Year <br />Vok kvio 4., if 7- 174 I .1-1 ------ DESIGNATED FACILITY ---0. r 18. Discrepancy <br />Discrepancy Indication Space Quantify Type Residue Partial Rejection Full Rejection <br />Manifest Reference Number: <br />Alternate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone: I <br />18c Signature of Alternate Facility (or Generator) Month Day Year <br />I I <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />1. <br />kit C iq <br />2. <br /> 01/ <br />3. 4. <br />20. E :sionted Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as in Item 18a <br />PrintetTyped Name Signature Month Day Year <br />_ /144W7la--) Pi/t/t4•404""1 /4---"" I/Z 170219 <br />EPA Form 8700-22 (Rev 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />