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TRANSPORTER: Johnny Owens LAST PAGE Hiease print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number �T 2.Page 1 of 3.Erger ency t esponse,P.hone 4.Manifest Tracking Number AR0000,,3301 ,,,, w::,, WASTE MANIFESTJ "j► �, SKS 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address)- ,: 4':,0 Auto F;i.:3 i.a `k w:a t.A 9 376,-•0tt Generator's Phone: i~51-832-1400 6.Transporter.1 Company Name ,... U.S.EPA ID Number ;:+'t s t'Ems INC 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address THERMO FLUIDS INC U.S.EPA ID Number 12533 SE CARPENTER O 503-•780-21616 Facility's Phone: 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.Nol. 13.Waste Codes 1-NQW-RCRA HAZARDOUS WASTE, St.,i-10 o D AIMED/UNDRA:I:NCD USED DIL I"IITr*.4) w z 2. L C7 3. 4. 14.Special Handling Instructions and Additional Information TSD: TPO 82, 2097 18341.; :tlh EMERGEN'I"Y#£QUO--AbS-17,60-CH/SI4/1'F'I-Cont,,°act retained b yenereto J. t 1. �,7-y �••,:•.r ',nrt� •� :.., +�;+.; y •. .� •t _ r 15. GENERATOR'S/OFFEROR'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. Generator's/Offeror's Printed/Typed Name Signature Month Day Year J 16.International Shipments F ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: w17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year O CL z Transporter 2 PrintedlTyped Name Signature Month Day Year F 18.Discrepancy 18a.Discrepancy Indication Space Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U u� Facility's Phone: w18c.Signature of Alternate Facility(or Generator) Month Day Year a Z H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) � 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a rrintedlTyp ed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY