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Pleaseprintor type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page t of 3.Emergency Response Phone t Manifest Tracking Number WASTE MANIFEST CAL000337276 600-424-30U 006418672 QBF 5.Generator's�{arae� M itirg Addres Generators Site Address(8 different than mailing address) PaCI ,C tttanoi� 3028 Navy(Drive Stockton,CA 95206 20"51.4D77 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number Heritage-Crystal Clean,Inc ILR000130062 7.Transporter2 Company Name U.S.EPA ID Number 8,Designated Facility Name and Site Address U.S.EPA ID Number US ECOLOGY HNVY 95 Beatty,NV 85003 NVT330010000 Fadlitys Phone: ga, 9b.U.S.007 Description(including Proper Shlpping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13.Waste Codes HM and Packing Group(d arry)) No. Type Quantity WtAd. 1. ce p P 312 o Containing Oil) CW Q a 1121 z. Non RCRA hazardous Waste, solid, (Oily Debris) 3� DT P 352 300- 3. • e Q o 0 G 4. L L 14.Special Handling Irstructiore and Additional Information 171 1 9b.2) oily debris 0070128300-6468 ERG#171 9bA) 15. OENERATOR'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 irdemational and national governmental regulations.If a shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknawledgment of Consent I certily that the waste mirihization statement identified in 40 CFR 262.27(x)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is t>ve. GenerarorsfOfferors Pdntedfiyped m Signature Month Day Year 28 , eJ F 18.International Shipments Olmport to U. . ❑Export from U.S. Port of entrylexit Z Transporter signature(for exports only): Data leaving U.S.: W 17.Transper erAdugwledgment of Receipt of Materials aTransporter 1 Printed(Typed Name Signature Month. Day Year a ii;:1J IQ I I a4 I W ransporter rtntedRyped a Signature Month Day Year r /C 18.Discrepancy 18e.Discrepancy Indication Space ❑Quaintly ❑Type ❑P al Re ❑Full Re' _ Residue )action lection Number:be: I ' 18b.Alternate Fadtity Genetator) U.S.EPA ID Number J V W FacilYs Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z y19,Hazardous Waste Report Management Method Codes(i.e.,codes fair hazardous waste treatment,disposal,and recycling systems) G 1. 2. J. 20.6dsiga ted Facility Ovmer air Operator.Certification of recelpt of hazardous materials covered by the manifest except as noted In Item 18a Printed/Typed Signature Month Day Year EPA Form 8700.22(Rev.12-17) ous editions are obsolete. DESIGNATED FACILI7Y TO EPA's e•MANIFEST SYSTEM