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Please print Or type. Form Approved. OMB No. 2050-0039 4 GENERATOR ). I UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1. Generator ID Number <br />CAC 0 0 3 1 2 8 9 0 8 <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone <br />(408)363-3678 <br />4. Manifest Tracking Number <br />016133604 FLE <br />Generators Name and Mating Address Generators Site Address tif different than mailing address) <br />METAL FINISHING SOWTIONS (IX) METAL FINISHING SOLUTIONS (IX) <br />870 COMSTOCK ST 9999 S AUSTIN RD <br />SANTA CLARA CA 95054 MANTECA CA 95336 <br />Generator's Phone: 909 798-93218 I <br />Transporter 1 Company Name U.S. EPA ID Number <br />ALL CLEAN HAZARDOUS WASTE REMOVAL, INC. I CAD982492399 <br />Transporter 2 Company Name U.S. EPA ID Number <br />I <br />Facili <br />Designated Facility Name and Site Address U.S. EPA ID Number <br />US ECOLOGY NEVADA <br />HWY. 95 11 MILES SOUTH OF BEAM <br />BEATTY NV 89003 <br />I NVT330010000 es Phone: 775)653-2203 <br />pa. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes RA and Packing Group (if any)) No. Type Quantity Wt.No t. <br />X <br />1 UN3252, CORROSIVE SOUD, BASIC, INORGANIC, N.O.S., 8, PG-III <br />(SODIUM HYDROXIDE) 1 <br />DF I 2. 0 P <br />181 1 <br />1 <br /> <br /> <br />I _ <br />i <br /> <br />14. Special Handling Instructions and Additional Information - ACH W00231051 1 18991 - GB " BIU.TO ALL CLEAN PO*18991 "• - <br />9b1)070127495- 10939 - CONTAMINATED DEBRIS I x cc I n i i <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, ant are classified, packaged, <br />marked and labeled/placarded, and are in all respects In proper condition for transport according to applicable intemafionaland national governmental regulations. If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment confomi 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 I am a large quantity generator) or (b) (ifl am a small quantity generator) is true. <br />Generators/Offerors Printed/Typed Name Signature / . Month Day Year <br />el^C-01 Ve. t r / I Cif e/------- L7 It 6 I 24 <br />_I <br />F.-. <br />_?.. <br />16. International Shipment <br />El Import to U.S. El Export from U.S. Port of entry/exit: <br />Transporter signature (for exports only): Date leaving U.S.: <br />1: 17. Transporter Acknowledgment of Receipt of Materials . TRANSPORTE Transporter 1 Pnnted/Typed Name Signature Month Day Year <br />/1/7 I‘Xe cr love,/ 1 v? It6 vir <br />Transporter 2 Printed/Typed Name Signature Month Day Year <br />I I I 1 4---- DESIGNATED FACILITY --* ' 18. Discrepancy <br />Discrepancy Indication Space LI Quantity Type El Residue El Partial Rejection Full Rejection <br />Manifest Reference Number: <br />Alternate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone: I <br />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 />Ik1912-. <br />2. 3. 4. <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as hoed in Item 18a <br />Printefinaped Name Signature 1 0 Month Day Year <br />i _I I (5N 1-1.2, riA -r-L____________. <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. Se..