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Please pnnt or type. Form Approved. OMB No. 2050-0039 4 GENERATOR * I UNIFORM HAZARDOUS WASTE MANIFEST 1 Generator ID Number ern_3157226 2 Page 1 of 1 3 Emergency Response Phone 1-13$0.547-7a57 4. Manifest Tracking Number 016468277 FLE Generator's Name and Mailing Address Generator's Site Address Of different than mailing address) 09xeas,telta Way hirOir3 t itteca Road Manteca, CA 95337 Manteca, CA 95337 Generator's Phone: I Transporter 1 Company Name U.S. EPA ID Number Adas Emirciimental Scludons I CAR000295220 7 -raris,7oner 2 Company Name U.S. EPA ID Number Tammy Recycling Inc. 1 CAR000194217 Designated Facility Name and Site Address U.S EPA ID Number Reciclacksa Taman de Ataxic% S.A. de C.V. Can. Fed #2 Mex-Tij .Kni 121, San Paso kl)C1309191)01 Tecate. Baja CallIonna, MN CP21530 Facility's Phone: I ga. 9b. U.S. DOT Desctiption (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit Waste Codes 13. HM and Packing Group (f any)) No. Type Quantity VVt.Nol. X 1 U N1283, Waste Paint related material (including paint thinning,343 drying, ramming; or reducing compound], 3 : I, Pa 1 DF l -7 ' P D001 0035 -F003 2 3 4 14 Special Handling Instructions and Additional Information Document: 0328333 1) iRmeRa. ERG/1128 /140 Primary Exporter Tammy Recycling Inc. 02607419E/20; a2e9?51CIEt-0252117iei21 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, arri 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 Pnmary 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) (ill am a large quantity generator) or (b) (ill am a small quantity generator) is true Generator's/Offeror's Printed/Typed Name Signature Month Day Year J-51,172- -1---"Thrt- 112-117 1 )-i-, _, I.— M International Shipments Import to U.S. Export from U.S. Port of entry/exit _nog Transporter signature (for exports only) Date leaving US .• c2N/V20 Z2. re a, Transporter Acknowledgment of Receipt of Matenals TRANSPORT' Transpo er 1 Printed/TypecJ,me Signature Month Day Year i / 'l atr-i10.7 .47"7 I 1r--It 7 im Transporter edrryped Na e Signature Month Day Year .7.4..)\•••y %.....-- I (2 . \\c/1 1°3 1 °8 1 Z-Z 4---- DESIGNATED FACILITY --+ I E Discrepancy 18a Discrepancy Indication Space Quantity LI]Type Residue LI Partial Rejection LI Full Rejection Manifest Reference Number 18b Alternate 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 Was e Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal. and recycling systems) 1 14020 2. 3 4 Designated Faci ity Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as ncted in Item 18a , \ Printed/Typed Name (JO Signature Vi a Lc I \ . Month Dpy Year A ' 1-) itt-t vo EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED AC IT 0 EPA's e-MANIFEST SYSTEM