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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAC003008174 1 800-624-9136 015482457JJK <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> FEDEX FREIGHT <br /> 700 E.ROTH RD <br /> French Camp CA,95231 <br /> Generators Phone: 800-624-9136 <br /> 6.Transporterl Company Name U.S.EPA ID Number <br /> PATRIOT ENVIRONMENTAL SERVICES CAD053866794 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> CROSBY&OVERTON CAD028409019 <br /> 1630 W.17TH STREET <br /> LONG BEACH CA,90813-0000 <br /> Facility's Phone: 562-432-5445 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity M.Nol. <br /> I.NON RCRA HAZARDOUS WASTE SOLID <br /> W <br /> 13 DM 4950 P <br /> 352 <br /> Z 2.NON RCRA HAZARDOUS WASTE LIQUID <br /> 1 DM 45 G <br /> W <br /> 223 <br /> 3. <br /> 14.Special Handling Instructions and Additional Information <br /> Line 1:Line 2: <br /> 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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> 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. <br /> Generato slOffero s Printedflyped Name Signature Month Day Year <br /> 04 03 2019 <br /> 16.International Shipments <br /> F Import to U.S ❑Export from U.S. Port of entry/exit: <br /> Transporter signature for exports only): Date leaving U.S.: <br /> U-1 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printedfryped Name Signature Month Day Year <br /> O <br /> � 04 03 2019 <br /> z Transporter 2 Printedffyped Name Signature Month Uay Year <br /> a <br /> r- <br /> 18.Discrepancy �L <br /> 18a.Discrepancy Indication Space Quantity SII ype ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> F— 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Q <br /> LL <br /> Facility's Phone: <br /> w 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> r— <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 <br /> H141 H135 <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> Susan Roberson Susan Roberson 04 11 2019 <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />