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Please print or type. Form Approved.OMB No.1 2050-0-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page i of 3.Emergency Response Phone 4.Manifest®lr�l g Nymicer �®� ��I� WASTE MANIFEST CALOOOVJ95F.r.3 916-_3:1.6747 17 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) ATLANTIC AIAATiON .$FLaVI CL S 6864 S. L1140SERGH ST STOCKI'ON,C.A. %205 Generator's Phone206534.0W 6.Transporter 1 Company Name U.S.EPA ID Number R ,IA05i ENVIRONMENTAL SERVICES INN. C%x110440035E�.a 7.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address PACIFIC RESOURCE RFCOn/ERY U.S.EPA ID Number 1160 EAST PiCO BLtyD. CAt09252405 LOS ANGELF£,CA %4123 Facility's Phone:600-4%y-7145 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit and Padding Group ,f an 13.Waste Cedes HM PC any)) No. Type Quantity Wt.Not. 1. I1N12D3,WASTE GASOLINE,3,PGS# fi�•, � $-"7, bac '� G 331 DWI Di �a Z 2. UN113Z. WASTE FL IXAABLE SOLID ORGA.h1k";, NOS,4.1, 11 P 357 DC01 0016 r; (OA tiOLINE,0E0fil9l 3. 4. 14.Special Handling Instructions and Additional Information 9B-1)PROFILEM711000 ERGp1128 952)PROFILE1g 17110103 ERCiyi133 E.R. CONTRACTOR: 1i IENIARONNIENTA.L HANDLERS SHOULD BE'!RAINED AND tISC APPRO"VL-D PPE 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,and are classified,packaged, marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.II export shipment and I am the Primary Exporter,I certity,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)if am a small quantity generator)is We. GeneratorslOfferar's PrintediTyped Name Signature Month Day Year, 16.International Shipments F ❑Import to U.S. ❑Export from U.S. Pod of entrylexi0 K Transporter signature(for exports only): Date leaving U.S.: W17.TransporterAcknowledgmenl of Receipt of Materials Transporter 1 Prioted/ryped Name Slgnat Mo98L' Ye QZ Transporter 2 Printedrryped Name Signature Month Day Year K F } 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity Type ❑Full Re ❑T e ❑Residue ❑Partial Rejection lection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w Or.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 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 Printed7ryped Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY