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Please print or W.(Form deeigned for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM 1-1A2ARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Resfonse Phone :MO14054417 fest Tracking Number WASTE MANIFEST CAL 0 0 0 2 9 4 4 3 9 1 (800)424-9300 JJ K 5.Generator's Name and Mail' Address Generalor's Site Adcress(if different than mailing address) JIFFY LUBE#1178 1648 E. HAMMER LN. STOCKTON CA 95210 Generators Phone: 209 952-8760 6.Transporter 1 Com an Name U.S.EPA ID Number ASBUR�'ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 7.Transporter 2 Company Name U,S.EPA ID Number 8.Designated Facility Name and SIIeAddress U.S.EPA ID Number EVOQUA WATER TECHNOLOGIES LLC 5375 SOUTH BOYLE AVENUE LOS ANGELES CA 90058 CAD 0 9 7 0 3 0 9 9 3 Facilltys Phone: (323)277-1500 ga, 9b.U S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12 Unit 13.Waste Codes HM and Packing Group(f any)) No. Type Quantity WLNoI I NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLIDS) ��7•" 352 w D 420 P — L 2 3.- 4. M.Special Hand1mg Instructions and Additional hformallon EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 NAERG#9131:171 *PROFILE#9B1:AP199195 OILY SOLIDS APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT 'J 1--- TSL 2ol /Av g 15. G ENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare Thal the contents of this consignment are fully and accurately described above by the proper shlpp'ng name,and are classified,packaged, marked and labeledrplacarded,and are In all respects In proper condition for transport according to applicable International aid national governmental regulations.N export shlpment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknoWedgmenl of Consent. I cartily that the waste minimization statement Identified In 40 CFR 262.27(a)(If I am a large quantity gener r)or(b)(If I am a small quantity generator)is true, n ratorslOffaror's"edlTyqW Name alure Month Day Year .-.l 16.international Shipments 1— 1:1Import to U.S. Export from U.S. Potofentrylexll: ? Transporter signature(for exports only)l Date leaving U.S,: 17.Transporter Acknowledgment of Receipt of Materials lran• or 1 Prinla yped Signature Month Day Year a asl& Transporter 2 PrinledlTyped Namf Month Day Year t-- 18,Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residte ❑Partial Rejection ❑Full Rejection Manifest Reference Number, 16b.Alternate Facility(or Generator) U.S.EPA ID Number _J V ►ate Facifilys Phone: 0 I Be.Signature of Allernale Facility(or Generator) Month Day Year t^— Q Z 19.Hazardous Waste Report Management Method Codes(i e.,codes for hazardous waste treatment,disposal,and recycling sy:,lems) 0 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt offiazardous materials covered by the manifest except as noted in Item 18a PdnledlTyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)