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2v.s1_ Please print or type.(Form designed for use on elite(12-pitc,�l typewriter.) G83562926-002 SC PPW 3Form Approved.OMB No.2050-0035 UNIFORM HAZARDOUS 1.Gerterator.jD Number_ 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST G A T D 0 0 6 i 8 6 3 7 j (800)483718 003990728 FLE 5. nerators m nd Maili es Generators Site Address(if different than mailing address) esoro efinm9,0ark(etingCompany 3003 Navy Drive SAME Stoon,CA 95206 Generator's Phone: (209)466-8800 6.Transporter 1 Company Name U.S.EPA ID Number Cl@an I aftr*Ermronrr"al SwAoaf,Inc M A D.0 3 9 3 2 2 2 5 0 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number OwnH@tuI fo I hwlhwLLC LAD980670276 2500 West LAkem Rand ButtonvAllow,CA 93206 Facility's Phone: (661)76 -6200 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13 Waste Codes HM and Packing Group(if any)) No. Type Quantity WLNoI. aNON RCRA HAZARDOUS WASTE SOLIDS,(DIESEL) CO/ 611 w � , i z 2. W 3. i t I I 4. I I 14.Special Handling Instructions and Additional Information 1.CH4719S3B /6 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 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 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)(if I am a small quantity generator)is true. Generalor'slOfferor's Printedriyped Name -- ature Month Day--7e-ar �J 16.International Shipments r ❑Import to U.S. ❑Export from U S. Port of entrylexit: Z Transporter signature for exports only): Date leaving U S.: LU 17.Transporter Acknowledgment of Receipt of Materials ' Transporter 1 PEn rintedrf Name Signature on ay Year CL I I I�I QTransporter 2 PrinteNTyped Nbme Signature Month Day Year F 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑ResidueEl j j Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ U a �+ Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year H a Z a, 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLI 1. 2. 3. 4. H132 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 183 Printedrryped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)