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;I_ SK SHIP# 229212583 1111111111 1111111 Please print or type. 0 0 Form Approv6d.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page,1 of 3. me4n Rgspopse Pty 4.Manifest Trac Number WASTE MANIFEST CAR000039370 �. +C 4btf-� t Q! 10071,91886 SKS5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) V I�17 Escalon Premier Brands Inc. 1905 Mchenry Ave F_SCALON CA 95320-0000 Generator's Phone: 209-552-6051 6.Trggpprt!rl O r�nv-Name SYSTEMS INC U.S.EPA ID Number T X R000081 2 05 7.Transslpoortterl2 Company NaamNe U.S.EPA ID Number CLEAN HARBORS ENV SVC INC. MAD039322250 8.Designated Facility Name and Site Address CLEANHARBORS OF BUTTONW I LL_OW U.S.EPA ID Number 2500 L.OKERN ROAD BUTTONWILLOW , CA 93206 561-752-6200 CAD980675276 Facility'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.NOI. of 1- NOME NON RCRA HAZARDOUS WASTE SOLIDS, tali P 35rP. o (GREW), */-A- O z 2. w 0 3. 4. 14.Special Handling Instructions and Additional Information TSD:BL 808495,.3,7 ES 12014 CSCE 24H EMERGENCY#800-468-1760-CH/SK/TFI-Contract retained by generator confers a envy arathori y on initialsubstitute 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. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or b)(if I am a small quantity generator)is true. General /,ffe6es Pri t drryped Name Signature Month Day Year 16.International Shipments ❑Import o U.S. ❑Export from U.S. Port of entrylexit: ? Transporter signature(for exports only): Date leaving U.S.: IX W 17.Transporter Acknowledgment of Receipt of Materials 11-- Tr porter 1 Pytedfrype ame Si Month Day Year 0 Mn , N Tr er 2P4RIladQyped Name Si ur �" Mon h Day Year -00 �.•� "'j, 30 1 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Typej j ❑Residue ❑Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U I Facility's Phone: C3 18c.Signature of Alternate Facility(or Generator) Month Day Year a 2 N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C 1. 2. 3. 4. H 13 2- 20. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pdntedffyped Name Signature Month Day Year o /Z 117 EPA Form 8700-22 Rev.12-171 Previous editions are solete. DESIGNATED FACILIT 0 EPA's e-MANIFEST SYSf EM 1)8681139/1879273