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i&ease print or type. Form Approved.OMB No.2050-0039. UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST C A I_ 0 0 0 4 2 4 8 .1 7 18M 6249136 020351_405 JJ K V 5.a[ t6daftli , & 0 hHT�n 56SHT LINE INC. A946GVEd eNG . 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 Transporter 1 Company Name U.S.EPA ID Number ae Patriot Envlronr�entaI Services C A D 0 5 3 8 6 6 7 9 4 7.Transporter 2 Company flame U.S.EPA ID Number B.I�e �FgahtS e address t� F� rr r EpgliT Ci� C37$ry� 1�IV .;t r ❑ i I7r Ur ctt•, umber 1630 WEST 19TH STREET .> 'LrF � LONG BEACH CA 90813 .o ; , i r.:c,rsiaa OF 0 2 8 A 0 9 0 1 9 Facility's Phone: 800 827-6729 w_- 9b.U.S.DOT Descd Von(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 110tal 1' a 9a. p� (� 9 p pp 9 J 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wtiva 1UN 1950,WASTE Aerosols, tlarraMbla,beach not exceeding 1 L 001 331 „ o capacity) 2.1 � ( DF 3 OP P LU � 2UN1993,WASTE Plant' ruble NgWds,n.o.s. Opt 551 c� 3, PGIII(LAB PACK) 0,01 pp t 5�() P 'NON RCRA HAZARDOUS WASTE LIQUID(LAB PACK) 002— 551 }( 47 ©—Iq � VJ S 1 m V t�S id�Q GNe 5, Dti01331 14 al uc1' nd A nal fo ion 149 PETROCHEM PO# H37542-20 CA5595, CA"596, CA5597,CA5659,CA5659,CA5663,CA56B9 + Vbo� D 15. GENERATDR'S10FFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the propershipping name,and are classified,packaged, marked and labeledlplacarded,and are it all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and l am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 4 I certify that the waste minimization statement identified in 40 CFR 262.27(x)(if 1 am a large quantity encrator)or )(if I am a small quantity generator)is true. Ge r tor'1 Offeror' ince f,ped N ke ( Signat J , � bay© dear C1 ! l _j 16.in rnational Shipments 11 Import to U.S. ❑Export.from U.S. Port of entrylexit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter rintedlTy. ed ame Signature Month Day ear IVI Z Transporter 2 PrintedJyped Name Signature Month Day Year 9 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quanti T e ty ❑ yP ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: F 18b.Alternate Facility(or Generator) U.S.EPA ID Number U rat Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 20.Designated Polity Owner or Operator:Certif tion o eceipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped N me - Signature Month }}Day Ye ° u ' ` l EPA Form 8700-22(Rev.12-17) Previous editions are bsolete , DESIGNATED FACILITYTO GENERATOR