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Please print or type. <br />I <br />I <br />i4) 2050-0 3' <br />A UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1. Generator ID Number <br />CAC003157226 <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone <br />1-866-547-2857 <br />Form Approved. OTB <br />4. Manifest Tracking Number <br />016 6 8 6 4 2 7 • FL . 5 Generator's Name and Mailing Address <br />_p Singh <br />Castellina Wt <br />Manteca, CA 95337 <br />Generator's Phone: I <br />Generator's Site Address (if different than mailing <br />21908r tain hteca Road <br />Manteca, CA 95337 <br />address) <br />Transporter 1 Company Name U.S. EPA ID Number Atlas Emironmental Solutions CAR000295220 <br />Transporter 2 Company Name u.S. EPA ID Number <br />EngrOnMantal Management Technologies, Inc- 1 CAR000183574 <br />f.gemitni Faiiirwg4efkgectuti U.S EPA ID Number <br />31915 Industrial lane A211090520478 Parker South, AZ 85344 <br />Facility's Phone: <br />ga <br />NM <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10 Containers 11. Total 12. Unit e C)1,s and Packing Group (if any)) No Type Quantity VVt.Nol. 13. Was -‹ GENERATOR - .., 1 . Non-RCRA Hazardous Waste, Liquid (Latex Paint) <br />OF 2...00 P <br />291 <br />2. Non-RCA Hazardous Waste, Liquid (011) <br />1 De <br />re <br />1 e il.)0 <br />221 <br />Non-MRA Hazardous Waste, Solid (Oily Solid)352 <br />2 OF 3‘./S <br />4. Non-RCRA Hazardous Waste, Liquid (Surfactants) <br />I rJF 2S <br />14. Special HandliziIr4s,tkueicns and Additional Information Duc.urnvnt: D328332 <br />1) EWS0 2) EWS12A1-04 3) EWS l91141 4) EVVSINI-1- <br />BS la Atl <br />7..lt ss i w 2 -is 23,SS 11, IS <br />5. GENERATOR'S/OFFEROR'S CERTIFICATION: thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, ard are classified, <br />marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable internationaland national governmental regulations. If export shipment and I am He <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment 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) (if I am a small quantity generator) is true. <br />pE caged, <br />P irery <br />Generators/Offeror's Printed/Typed Name Signature Month <br />) ' 1 "7?" r I .9-- <br />Cw Year <br />tri , <br />r-LII 16. International Shipments <br />Import to U.S. Export from U.S. Port of entry/exit: <br />g Transporter signature (for exports only): Dale leaving U.S.: <br />Or ut 17 Transporter Acknowledgment of Receipt of Materials TRANSPORT Transporter 1 Printed/Type Name Signature Month 'Ab 9 I <br />Dr Year .... ( , .41 <br />Transpo <br />1 <br />Pr! edjyped Nam( Signature <br />1,1 c-0 E7" YO 11 1 -k---( n,ez Month <br />I <br />Da'- Year <br />ic--: 1 z .. 4---- DESIGNATED FACILITY ---)- 18 Disciepancy <br />Discrepancy Indication Space LII Quantity LIType Residue Partial Rejection F <br />Manifest Reference Number: <br />II Pe ection <br />Alternate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone: <br />Signature of Alternate Facility (or Generator) Month Czy , <br />19 Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />1. 11. Ix/1 2.4.114// 3. <br />,g-il <br />20. Designated Fac Owner or Operator: Certification of receipt of hazardous materials covered by the manifest c t as nded in Item 18a <br />PrintedfType Nam i Signat - °A 0.1 . Year , I <br />EPA Form 8700-22 (Rev. 12-17) Previous e i ions ar obsolete. DESI ADYTO EPA's e-MANIF :,-T SYSTE