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W SHIP* 2352444-1-- 1`QL-1—P-=-1--.;,type. 2—Page I of 3.Emergency —14.Manifest Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number Rcy Response,Phone Tracking Number ^t — 1110 WASTE MANIFEST NO 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Brantis Inc. ESIC-ALON CA 95320-1&*L�k`--, Generators Phone: . 051 6.Transporter-1 Comp1nj1 Q a U.S.EPA ID Number 4 SYS JEms INC 7.Transporter 2 Company Name U.S.EPA ID Number MID Mc. 8.Designated Facility Name and Site Address CLEM HARBORS DEER TRAIL LLC U.S.EPA ID Number 16IS E H18"Y 36 DEER TRAIL co 68105 Facility's Phone: 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./Vol. HAZAMMIS WASTE, LIQUIlL. 0 (SILVER), 9, PS- III 2. 3. 4. 14.Special Handling Instructions and Additional Information iiER8#171.-. 760-Cki SK!IFF Z�'-C ant ract r-iiii,tained 'by generacor confers agency avoivt� . - 0 -1 -h r t,"I t: �%,.. j-. - 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)(ifl am a small quantity generator)is true. Gqnerators/Offeroes Printed[Typed Name Signature Month Day Year X, e. 16.International Shipments 0 Import to U.S. ❑Export from U.S. Port of entry/exit': Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LLI FE Transporter 1 P I I d/T d) yp!qj4 nn e am? Signahffe, it Month Day Year Z Transporter 2 Printed[Typed Name -SI§Ature Month Day Year 9 F- 18.Discrepancy 18a.Discrepancy Indication Space El Quantity ❑El Type ❑Residue Partial Rejection ❑Full Rejection Manifest Reference Number: >- 18b.Alternate Facility(or Generator) U.S.EPA ID Number F- Facility's Phone: In LLj 18c.Signature of Alternate Facility(or Generator) Month Day Year 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) Ca uJ 1 2. 3. 4. I 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