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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Ma Rest Tracking Number CWASTE-MXNIFEST C;A R 0 0 0 2 1 H 5 !i C 1 (800)4 14053312 JJ K 5.Generator's Name add Mailing Address Generators Site Address if different than mailing address) ECS REFINING LL - EC.S001 2222 S SINCLAIR AVE Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number P'•Bl.i _.'y"fNICEB C.A D 0'—'&,2 7 7 0 3 t: 7.Transporter Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number neME1,11,110 J t:FIl 2000 N_ALRMEiiA StREET GOMKON UA 40 A r!) I.7r1 Facility's Phone: -�, r,,� -, t; 9, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(fany)) No. Type Quantity Wt.Nol. 13.Waste Codes 0 1, NON-i?—RA HA2A(1' SF' UOUS WAT ..IX}L11O(t':7 Hy ENE.GLYCOL K � i• r 2 2. w 3. .. I f• I w 4. e 14.Special Handling Instructions and Addflonal Intonnation EMERGENCY CON1'A^TCHEMTREG I-A6O,4214-931,10 NAERG9 9B1 171 " PROFILE 0 981 3F53541 F.THiLENE GLYi 0; 30LUTIOW ' ' APPROPRIAFF Pf_Rt30Nk PROi F(MVE EVIIIPMFNT _ l 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 ccnfonn to the terms of the attached EPAAcknowledgment of Consent. I certfy that the waste minimization statement identified in 40 CFR 262.27(a)(f I am a large quantity generator)or(b)if I am a small quantity generator)is true. Generato'slOferors Printedrryped Name Signature _ Month Day Year 16.International Shipments f— ❑Import to U.S. ❑Exportfrom U.S. Pod of entry/exit: z Transporter signature(for exports only): Date leaving U.S.: Ulu 17.Transporter Acknowledgment of Receipt of Materials OTmnsporter 1 PrintedRyped Name Signature Month - Day Year o- : /• N ' R Transporter Printed/Typed Name Signature Month Day Year K F— 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑P.mei Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facilitys Phone: tom= p q•n..,.,... w18c.SignatureofAhernate Facility(or Generator) i"••' !Month Day Year Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item ma - PE(''e,191T/Sc: ^-i' ^ Printedrryped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY