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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 1•Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manifest tracking Number WASTE MANIFEST ` J J K 5,Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Rape' . So StOC ton St. Stor-kton, CA 95206 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number ry WASTE OIL 7.Transporter 2 Company Name U.S.EPA ID Number yStM:? a�� a 8.Designated Facility Name and Site Address U.S.EPA ID Number : tL Transfer Facility 5 RlghwaY 95 , YuMa . AriZona 85365 r Facility's Phone: 9 2 �' -9 82 8 A Z �0 000 521 � �� ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit HM and Packing Group(if any)) No Type Quantity wt./Vol. 13.Waste Codes 1. (Oily sol - 2 u.1 3. 4, 14.Special Handling Instructions and Additional Information yy LL b F, $ �J i.. 1 �{C4 1 i�C sa�l f} .} ,t:a PE T 15. GEN ERATOR'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 label edlplacarded,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 1 am a small quantity generator)is true. Generator'slOfferor's Printed/Typed Name Signature Month Day Year i � tB.International Shipments • I Z ❑Import to U.S. ❑Export from U.S. Port of entrylexit; Transporter signature(for exports only: Date leaving U.S.: 17.TransporterAcknowledgment of Receipt of Materials Uj aTransporter 1 Printed/Typed Name Signature Month Day Year Q Transporter 2 Printed/Typed Name Signature Month day Year [tC 18.Discrepancy 18a.Discrepancy Indication Space ❑ Ouantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 1$b,Alternate Facility(or Generator) U.S.EPA ID Number J_ CJ Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Cn 19.Hazardous Waste Report Management Method Codes(i.e_,codes for hazardous waste treatment,disposal,and recycling systems) LU 1 2, 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noled in Item 18a rted/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL CCPV