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Please print or type. Form Approved. OMB No. 2050-0039 < GENERATOR ) .., UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number rACT1031RIVFIR 2. Page 1 of 7 3. Emergency Response Phone 1.4166-6,17..28,57 4. Manifest Tracking Number 0 1 6 9 96 50 0 FLE Generators Name and Mailing Address Generator's Site Address (if different than mailing address) Certified Freight Logistics Certified Freight Log:10,9s 1344 White Court 37.720224, -121.52849 Santa Maria, CA 23458 Tracy, CA 95377 Generator's Phone: I Transporter 1 Company Name U.S. EPA ID Number All EmAronmental Senices LLC I CAL000421893 Transporter 2 Company Name U.S. EPA ID Number Atlas EnUronmental Solutions I CAR000295220 112esigoated Facility Nam and Site AdJreqs U.S. EPA ID Number t nvronmental Waste Solutions, Inc. 31915 Industrial Lane A2RO0052047a Parker South, AZ 85344 Facility's Phone: I ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes EthA and Packing Group (if any)) No. Type Quantity Wt Not. 1. Non-RCRA Hazardous Waste, Solid (ABSORBENT, CESEL) P 352 --i--._ 'I PiAl 5rip 2* Non-RCRA Hazardous Waste, Liquid s Ofil -c.) P 223 I 3. 4, 14. Special Handlin Instructions and Additional Informatio.n. 1 Document: 03s2579 1) EWS '10 2) EWS V-Vk BM to: Atlas 15 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, ard 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 lain 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) (ill ... . .00111117.generator) is true Gene s/O ror Print (pa Signa Z ./A , ' Month Day Year 5 iti_ I-- g 16. International Shipments Import to U.S. Export from U.S. Port of entry/exit: Transporter signature (for exports only): Date leaving U.S.: TRANSPORTER 17. Transporter Acknowledgment of Receipt of Materials Tran rt Pri iii e ed Nam Rilo 7 A Signature Month Day Year I q. I Transporter 2 Printed/Typed Name 1 ignature % . 1 With 1 6Da 12Y2_ear v ct,. 18. Discrepancy I'---- DESIGNATED FACILITY -----)- I Discrepancy Indication Space Quantity [11 Type Residue Partial Rejection Full Rejection Manifest Reference Number: Alternate Facility (or Generator) U.S. EPA ID Number Facility's Phone: I Signature of Alternate Facility (or Generator) Month Day Year I I 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1. g-1 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a Printed/Typed Na...— Sign nith ?1, y:.t (-)ovaill •nni,ff I n._ ILA EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM