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4 #AL SK SHIRK a;ate <br /> tv� <br /> Please print or type. I .� <br /> 1 Form Approved.OMB No.2050-0039 <br /> -c <br /> UNIFORM HAZARDOUS 1 Generator ID.Number ��- - 2.Pa a i-of m_ <br /> CAR000039370 9 _RV4i�gog11e Pqy�� a.ManBest Trackin Number �+�/�+ <br /> WASTE MANIFEST ' S 44tl—S./b10 007770166 'M <br /> 5.GeneustoYs Name and MailingAddresa <br /> Escalon Rreoier'Brands Inc. Geneaors SieAdd ass(ddi8eusnt hon mailing add ass) <br /> 1905 Mchenry Ave f <br /> ESCALON CR -0000 <br /> Gen"r*Des Phone: 209-552-6051 <br /> s.Traksppr)e iTn9y�,fe, SYSTEMS INC . . ONumber�+ usEPA <br /> 5F1F t� <br /> 7. nsporter2Company Name T X R00W(205 <br /> CLEAN HARBORS ENV SVC INC. U.S.EPA ID Number <br /> 8.Designated Fadh Name and Site Address MAD039322250 <br /> CLEAN HA . 'OF'.W'It:M1NCiTQN U.S.EPA ID Number <br /> 1737 EAST DENNI STREET <br /> 310-835-9998 WILMINGTON w , CA 90744 <br /> Facility's Phone: } � CAD044429835 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Haz N ass, ryy�i kei, ' <br /> 10.Containers <br /> HM and Packing Group('rf any)) 11.Total 12.Unit 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> a NON RCRA ARD WASTE LIQUIDS DM R 221 <br /> (O L W/ LESS T 10% WATER),-*?#- <br /> M 2. Lf <br /> 0 , <br /> 3. ryry <br /> V� <br /> 4. <br /> 143pecl Handling 111MUutims and Additional information <br /> WI E512014 t7SG. <br /> 24H EPIERGENCYA800-468-1760- /,AFI-Contract retut atiffl.tained b gene confers agency authori y <br /> 15. RATOR'S/OFFEROR'S CERTIF( N: hereby decla That the contents of this consgnto fare fully and y d above by the proper shipping name,and are classified,packaged, <br /> marked and r baled/placarded a (�pects in proper condition to transport accenting to app intern national governmental regulations.If expodshipment and I am Me Primary <br /> Exporte 1 ce that the conte s consignment conform to the terms f th attached AAcknox <br /> I sm minimizab lament identified in 40 C 2.27 a I am a la a 9ment o sent. <br /> O rg uaplity generator)or(b)(III am a small quantity generator)is We. <br /> G em s Printedlryped Na Signature <br /> 3 1f Y\) Q r (`, Month Day rYYea`r <br /> _a 181ntematlo (Shipments i )v ai aJ <br /> F? mport to U.S. ❑Fxport from U.S. P xit:Transport `/Jor exports only): <br /> W 17.Trans Ackrrowkygment of Receipt of Materials e r D 9 .5.: <br /> 1- Tre porter i Printed/Typed Name <br /> ,A{{A� nature <br /> y .. Y Cl 9 Month Day Year <br /> Z Transporter mmedl yped Name <br /> N /7 re Month Day Year <br /> I <br /> `' <br /> 18a.Discus Indication Space ' r <br /> Quantity t 1 `�, y,�t Ty - )/� ueQ Partial Re'edbn <br /> J[Zy' 1 ❑Full Rejection <br /> 18b.Alternate ility(or rpwrator) Manifest Reference Number: <br /> U.S.EPA ID Number <br /> LL Facility's Phone: 1 <br /> wC' 18c.Signature ofAltemate Faal (or Generator) <br /> Z Month Day Year <br /> N 19,Hazardous Waste Report Management Method Codes(i.e,codes for hazardous waste treatment,disposal,and recycling systems) <br /> W j <br /> t7 1. /! / l� 2. 3 <br /> / h 4. <br /> 1 20.Designated Feat ry/Owner o7 Dpemtpr:Certificaeon of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printad/fyped Name , Signature <br /> �•!NC% Month Day Year <br /> / -*-" <br /> EPA Form 8700-22 Rev.12-17 Previous editions are obsolete. <br /> 1)8681198/187974 DESIGNATED FACILITY TO GENERATOR <br />