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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response one 4.Manifest Tracking um or WASTE MANIFEST C A L: 10 0 +O 4-2 4 8 1 7 1.. , 8110 624-9136 020351266 JJ K s.�LDfeD�141INIO�i� REIGHT LINE INC. OLUf17�O�hAIIVI S4 mailln INC. 500 OLD DOMINION WAY 601 DARCY PARKWAY THOMASVILLE NC 27360 LATHROP CA 95330 Generator's Phone: 3 3 6 8 2 2 5 7 6 0 . t 1 6.Transporter 1 Company Name U.S.EPA ID Number Patriot Environmental Services CAD 0 5 3 8 6 6 7"9 4 7.TTQr��a��nssgporrttter2 Company Name � p� U.S.EPA ID Number I,-i.i[K&dgfily�!6N dress U.S.EPA ID Number.. , 1630 WEST 17TH STREET LONG BEACH CA 90813 Facility's Phone: 8W 827-6729 ICAD02840 9 0 1 9 9a, 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes r HM and Packing Group(if any)) No. Type Quantity Wt.Nol. ` UN a�3, wS e. l�nr c r�cr�� 060 QN Qr S. � L C L prc � � 11� Or 55 2' Nom FC e� �AZWDOUs KJA�7-fE qv C. P #� PAS Co T)f 2 �0 P 4. 14dgg,lHaodltng,IVkctiplb`Ed%gallpfor�gnn20-00004 PETROCHEM PO# H37248-20 j CA5398, CA5400, CA5413 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, marked and labeledlplacarded,and are fn 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 CFP 262.27(x)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Ge eratorslOffemr rinledrry ad ame Si at Month Day Year E f f y Mau UY 0 1� � International Shipments 1=- ❑Impart to U.S. ❑Export from I&S Port of entry/exit: ? Transporter signature(for exports only); Date leaving U.S.: W 17.TransporterAcknowledgment of Receipt of Materials LLJ Transporter 1 Printed/Typed Name Signatur Month Day Year 101 1 z .Transporter 2 Printedlfyped Name Signature I Month Day Year 18.Discrepancy 189.Discrepancy Indication Space ❑ Quantity Type Resfdue Partal Rejection ❑Full Rejection Manifest Reference Number: F}- 18b.Alternate Facility(or Generator} r>tt rtF3 EKrj.��L nnsrT K'as x� t;v.a ,3v�vA1 AND sl't�]tPD FOR SURSEQUPM Q{q0 Number IMPO`s,LL,Tr.LNT1.MN OR K:'SIL L:tUE,Z .S:OVERTON.INC,OPERATES 711H FACUI Y ANDER Ilu,�Mrf,S CTUtYIED TO T:❑i?1 <,4 T::':;•:::::"::3'.'7-,F•NT OF TOXIC SUBSTANCE CONTROL,TOGErH R - Q Villi THE C:7NVIP.Ot�t�!]il1i's.i..l •:-!7N,:�::r;;?C'i 111 ACCORDA111!1 THEPROV ONs OP . rL Facility's Phone: -,. 'G:_Ee.. „Y. Lir 18c.Signature of Alternate Facility(or Generator),:s-r,;�r,LL AND STATE TdN;CL-:5'.)NS, CROSSY & OVERTON HAS ALL OF nE NECESSARY Month Day Year L Q 'LiOMILS TO ACCEFr THE REFERENCED WASTE AND ALL THE WASTE HAS BEEN HAMUiED .CV01ROINGLY 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) co LLI0 1 4. 20.Desi/g/nateei Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrinteName / Signature �— Month Day Year / `f J if ee? EPA Form 8700- {Rev.12.17) Previous editions are obsolete. DESIGNATED FACILIT TO GENERATOR