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Please print or type. Form Approved. OMB No. 2050-0039 4 GENERATOR I UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number C A C 0 0 3 1 4 4 4 0 7 2. Page 1 of va. 3. Emergency Response Phone .415 ) 331-0328 4. Manifest Tracking Number 016612921 FLE Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) Alex Thompson Alex Thompson 4311:I RivPrhAnk. C:t 705 INI.Affthpr Ayrz Stockton CA 95210 rtockton CA 95203 Generator's Phone: 2 n Q 5 5 5 - 7 7 11 2 Transporter 1 Company Name US. EPA ID Number Excel Environmental Services 'CARO 0 0 2 7 5 2 8 9 Transporter 2 Company Name U.S. EPA ID Number All Clean Hazardous Waste Removal, Inc ICAD 9 8 2 4 9 2 3 9 9 Designated Facility Name and Site Address _ U.S. EPA ID Number Recicladora Temarry De Mexico it.•,- ct-C. k.-1/4' Carretera Federal No. 2 Mex San Pablo, Tecate BC Facility's Phone8 i p 27[1..g452 ivi XC 1 3 QE 1 9 0 0 1 ga 9b. U.S DOT Description (including Proper Shipping Name. Hazard Class, ID Number. 10. Containers 11. Total 12. Unit HM and Packing Group (if any)) No. Type Quantity Wt.Nol. 13. Waste Codes hON-RCRA HAZARDOUS WASTE, SOUD (OILY RAGS 8, DEBRIS) 0 0 1 OM 00136 P 352_ -- 14. Special Handling Instructions and Additional Information 1) TR217278 55G 0TH (OILY / DIESEL RAGS s ABSORBENT) ERG #171 PRIMARY EXPORTER: TEMARRY RECYCLING INC 020526110E/18 020529/10E/18 020514/9E/18 15 GENERATOR'S/OFFEROR'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, marked and labeled/placarded. and are in all respects in proper condition for transport according to applicable intemationaland 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. Verarror's Printed/Typed Na . v iiigiatur Vi Ck c / 2k, A-.) 0 VIVI A;temational i n , . Month Day Year 4/t:kith4 \r\-1 I tO 12? I Z 4 .k...)tivis F-L.J Shipments Import to U.S. X Export from U.S. Port of entry/exit: 1‘ Transporter signature (for exports only): Date leaving U.S.: -11i----f.;) Is t- TRANSPORTER Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day._ Year Austin Liggett I I 10 1Z-Z17-4 Transporter PnntediTyped m204 Signature / if i Month Day Year o(".... I 4.----__ 1/412g-121 DESIGNATED FACILITY Discrepancy 18a. Discrepancy Indication Space Quantity Type Residue Partial Rejection Full Rejection Manifest Reference Number: 18b, Altemate Facility (or Generator) U.S. EPA ID Number Facility's Phone: I 18c. Signature of Alternate Facility (or Generator) Month Day Year I I Hazardous Waste Report Management Method Codes (i.e.. codes for hazardous waste treatment, disposal, and recycling systems) 1 . 2. 3. 4. e ignated Facility Owner or Operator: Certifica ion of receipt of hazardous materials covered by the manifest except as ncted in Item 18a i P 'nted/Typed akEllUP_.1 Name iii\P CI n t. , UK hure) l [)0/10c- V fi N ( ., - Month 1 I Day Ye iqiZ1 EPA,bTm 8700- 2 (Rev. -17) mu edi6hs are ob DESIGNATED FACILITY TO EPA's e-MA/41FEST SYSTEM