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Please print Or type 4 GENERATOR o• I UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1 Generator ID Number <br />cAL000327765 <br />2. Page 1 of <br />1.0 <br />3 Emergency Response Phone <br />1-866-547-2857 <br />4. Manifest Tracking <br />0 1 6 4 <br />I ,..r. I rip), <br />Number <br />11 <br />VVG11. VII/. l'ill. LUUVMJU,)ti <br />2 0 6 FLE , `. Generator's Name and Mailing Address Generator's Site Address (if different Man mailing address! <br />WalgreenS #10631 Waloreens #10631 14780 Harlan Road 147so Harlan Road Lathrop, CA 95330 Lathrop, CA 95330 <br />Generators Phone: I <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />All En4rontnental Senices LLC FAL000421863 <br />, 7Transpotiter 2.Compeny Name. U S. EPA ID Number Atlas' Enwormental Solutions FAR000295220 <br />ittDe Fa . itylii Sitzgiv 8XICQ. S.A. de C.V. U.S. EPA ID Number <br />Can-. ed #2 filex- ijKrn 121, San Pablo liA)C130619001 Tecate, Baja California. MX CP21530 <br />Facility's Phone. <br />l a 9b U.S DOT Description (including Proper Shipping Name, Hazard Class. ID Number. 10. Containers 11 Totai 12. Unit m <br />li <br />and Packing Group ( any)) if No Type Quantity Wt Aid 13 Waste Codes <br />X <br />ILIN19133, WASTE FLAMMABLE LIQUIDS, N.O.S. (DESEL), 3, pc3t pita <br />20 <br />CM <br />t \O <br />-P--- <br />Gr <br />331 LAKI1 DIAS <br />1 Non-RCRA Hszardous Waist% Solid (ABSORBENT, DIESEL) DM P .3 2 <br />, <br />14 Special Handling Instructions and Additional Information I.N.c.timent. 0319839 <br />1) TR216232 ERO#128 2)1R216233 <br />. i Z-KS5 1 X 95 <br />Primary Exporter Temany Recycling. Inc- 026074/9E/20: 4126676/9 5:10137t5E/213 <br />1 4 GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are hilly and accurately described above by the proper shipping name, and 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 It export shipment and tam the Primary <br />Exporter. I certify that the contents of this consignment conform to the terms of • attached EPA Acknowledgment of Consent. <br />I certify that the waste minimization statement identified in 40 CF ° 262 27 lift a large quantity generator) or (b) (if I am a small quantity generator) is true <br />Signature . C'. nerator'sfOfferors Printed Typed Name (5\0 • A <br />1 % kLa 7s tillart A 1 A — # te , <br /> I MIPP <br />Month Day Year <br />..., <br />P- E <br />16 International Shipments <br />Import to U.S 11111111112 Export from U S Port of ent,,,ex,L _ .2517 <br />Transporter signature ((or exports only): Date lea,ing u 5 TRANSPORTER Transporter Acknowledgment of Receipt of Materials <br />Tran 1 Prin cifTyped me Signature Month Day Year %. <br />On --JCSej frICD'aC)'----- I 1-1 124/1Z( ranspcner 2 PAintid[Typer. Signature Month Day Year <br />9.6ilaty yIo rl. I 1 124f Iz( DESIGNATED FACILITY. Discrepancy/ <br />life Discrepancy Indication Space Quantity Type Residue Partial Rejection Full Rejection <br />Manifest Reference Number. <br />18i) Alternate Facility (or Generator) U.S EPA ID Number <br />. i <br />Facility's Phone <br />18c. Signature of Alternate Facility (or Generator) Month Day Year <br />9 Hazardous Waste Report Management Method Codes tiR codes for hazardous waste treatment disposal and recycling systems) <br />I <br />V1/440Z---e J <br />2 <br />\—CcO <br />3 <br />20 Design Facility Owner or Operator. Certification of reipt of hazardous matenals covered by the manifest except as nded in Item 18a <br />Printed:Ty e Name Signature Month Day Year klIfy <br />-----5-;o I tO I 7.0 11 i <br />orm ev. - rev ous edItionS are <br />DESIGMTMACILITY TO EPA's e-MANIFEST SYSTEM