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Please print or type <br />Form Agoroved. OMB No. 2050-0039 <br />A <br />cc c.. <br />g <br />LLI <br />UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1 Generator ID Number <br />CACD03181847 <br />2 Page 1 of <br />IV <br />3 Emergency Response Phone <br />1-866-547-2857 <br />4. 15iifit "f6ac6n §lugber_ <br />7 68 F L E <br />nerator's NarvideMaiEress <br />1 00811AQ on <br />G rators Site Agrg3(if different than mailing address) <br />3 .71 7, -127,11E295 <br />Lot Angeles, CA 90081 Tracy, CA 95377 <br />Generators Phone. I <br />Trosilorter.1 Company Name u _ . <br />M Environmental Senices LLC 6x6D0zayi 863 <br />I <br />7 atirtgi4nanainAsi solutions U.6AP AE610'2415220 <br />I <br />8 EeliiiiiiiFtiiiiirtirgliitEations, Inc. U.S. EPA ID Number <br />31915 Industrial Lana A2R000520478 <br />Parker South, AZ 35344 <br />Facility's Phone: I <br />ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number. 10. Containers 11, Total 12 Unit <br />HM and Packing Group if any)) No. Type Quantity WI/Vol. 13 Waste Codes <br />1.Non44.74,4 Hazardous waste. Solid (011--, 1-31.41, CULLAN I ) <br />-7--- <br />CM 21 kid P <br />352 1 4 GEM 2 <br />3 I <br />L 4 <br />Document: 0338674 14 Special HaNling Ins and Additional Information <br />1) EWS151 <br />1 1C6S Bil to: Atlaf <br />15 GENERATORISIOFFEROR'S CERTIFICATION: t hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, ard 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 If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. , <br />I cerbfy that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or b) (i small quantity generator) is true. <br /> <br />Generaf:/ eror's Pri ed/Ty Name pedi 6 ti,00.74 <br /> <br />0 <br />S reignatu Month Day Year <br /> <br />I tO 1 It <br />_1 <br />1.-- g <br />16, International Shipments — - <br />Import 10 U.S LI Export from U.S. Port of entry/exit <br />Transporter signature (for exports only): Date leaving U.S TRANSPORTER 17 Transporter Acknowledgment of Receipt of Materials . <br />ngr 1 int Tra p) <br />r <br />...---"-- iTYP8 tialleA) Z.....S /AidZ79 <br />I Signature Month Day Year <br />1 ti 1 V 121 <br />Transporter 2 Printed/Typed Name Signa s'*-- <br />\'\tti kk VA ej\iA\ I t <br />. Month Day Year <br />1 i i / 0 1 1 1 I V- I_4--- DESIGNATED FACILITY -0. 18. Discrepancy <br />Discrepancy Indication Space LI Quantity Type Residue 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 2 3. 4 <br />20. Designated Facility Owner r Operator. Certifica ion of receipt of hazardous materials covered by the manifest except as n in Item 18a <br />Printed/Typed Name <br />tAI\ t CC' V M—C21 <br />Signature <br />1- 119—%- I ANAir — <br />Month Day Year <br />Pv1.,-, I --) i 1 IL 14-d <br />EPA Form 8700-22 (Rev 12-17) Previous editions are obsolete DESIGJ'4ATED FACILITY TO EPA's e-MANIFEST SYSTEM