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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number <br /> WASTE MANIFEST CAC00334€715 1-866-547-2857 020183606 FLE <br /> Generators�U090T ff ili �4dd gNTER MAILING SUPER KING�FdOOrDtCENTERaddress} <br /> 8626 N. LOWER SACRAMENTO ROAD STE. 20 1449 W. MARCH LANE <br /> STOCKTON, CA}'95210 STOCKTON, CA 95207 <br /> Generator's Phone(925)2G 1-951 1 <br /> 6.Transporter 1 Company Name U.S-EPA Ifs Number <br /> Atlas Environmental Solutions FAR000295220 <br /> mror ID Number <br /> anliient � Mrry anagement Technologies, Inc. CAR000183574 <br /> tllvl��t3Rmfli�l vYaSi@eJOIUiions, Inc. U,S,EPA IDNumber <br /> 31915 Industrial Lane A2t0GG520478 <br /> Parker South, AZ 85344 <br /> Facility's Phone: <br /> 9a. gb•U.S.DOT Description{including Proper Shipping Name,Hazard Class,ID Number, 10 Containers 11,Total 12 Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No Type Quantity Wt,Not <br /> Non- KA Hazardous Waste, Liquid (Surfactants) 181 <br /> o 3 <br /> DM Sol P <br /> 2.woo_ M4Hazo,.-dcil v►rc+s� , Liptf� (Lk)( Pw'nf) Dfi 130 Ail - l <br /> 3 Ko►�- Rlr,� �t<�ts w�s�e, �,�urz C 3-,� �y�cv9�n 1 DF �'� � 3it3_ I <br /> 4eCO3L4�A4) <br /> 4 'I�_ <br /> 14 Racial Ha 1 n coons and Additional Information <br /> 1 ws� — a cos �r 3�[3� 3)L- y3�{a�j �r� y 3�1d8 <br /> 3 �s 1xss t xis 1 xs Bill to: Atlas <br /> 15 GENERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeletllptacarded.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 Acknowledgme of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262 27(a)(if I am a large quantity generator) r b}(ifI am a small quantity generator)is he. <br /> Gene ator'sl0fferors PrinledlTyped stamp Signatur Month Day Year <br /> _ 12S <br /> 16.International Shipments <br /> F El Import to US. Export from U. Port of entrylexiC _ <br /> K Transporter signature ffor exports only) Date leaving U.S., <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 PrintedfTyped Name Signature Month Daayy Year <br /> ^ <br /> 0 1 <br /> i Transpo ter 2 PnntedlTyped Nal Signature Month Day Year <br /> 9 ,� 9 � ) r <br /> 10.Discrepancy <br /> 180.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Reiection <br /> Manifest Reference Nuri <br /> 161b.Alternate Facility(or Generator) U S.EPA ID Number <br /> U <br /> Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator} Munlh Day Year <br /> H <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Godes(i e.,ic odes for haz rdous waste treatment,disposal,and re cling systems) <br /> c t 2. 3. 4 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous alerials covered by the manifest except ded in Item 16, <br /> PrintedrfypedName n�I � !� � /��I �0 � Sign! r}lion e <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. r�/]1 CIESIGNATEp FACILITY TQ EPA`s e-MAANNIFEST SYSTEM <br />