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Please print 0 rMor acknopNl id ez tft no maltetlr cjlarir, ;'35 O;Xurred either In ther hSTe7GtGTl7tlGS r1T In the prone a get?wfati 11P�ifmrMppr2r��tl.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator IR-.1 r 2.Page Uof 3.Emergency Response Phone 4.Maniffest Tracking Number <br /> WASTE MANIFEST C t F 9 ��a a r v F L E <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Oak Harbor Freight Liries nib <br /> 301.8 Loomis RdSm-ektan.CA 95205 4SANIE <br /> Generator's Phone:,,) a <br /> 6.Transporter 1 Comp`ariy ame U.S.EPA ID Number <br /> GleanHcrborsLcnviranalerY�dIservica Ez� <br /> 7.Transporter 2 Company Name ,r U.S.EPA ID Numf>ei <br /> / <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Numilar <br /> Clean i#arirmm El Dorado t.LC- <br /> 309 American Cirde A R D to 6 9 7 81 9 2 <br /> MRQY M�jn`p,Aft 717dy 0.a 9414, a 7- <br /> 9a' <br /> n9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> 1. <br /> C UAl3:09.WASTE.OWUANIC P'E OXiDr: 'YPF I-,i_±QUID, <br /> E ?i�.: y1C E:lD<=25%.c�9 � L➢S.a_$�i P'i:l''oX02. �...yam -•,�. i+" n.t .. - <br /> Z <br /> Z 2. <br /> ul <br /> 494'11104 llli&ATF'd'fFGAN;I('PFt:'.!0&!JnFJ's P F r_3fKa1r6 i asLs_:6 RI . <br /> X ACID,"YORUGE ex) <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> r ir. -,r ••t,y <br /> 15. GEi4ERATOR'SlOFFEROR'S CERTIFICATION:I hereby declare that the contents"of this consignment are ily'a id six riiafely descn" a'`ve fiy 'e prayer's ppi risme;aka're'CI25'S�fl�drP�C�(afJ�d-a,c; <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)(ill am a small quantity generator)is true. <br /> Generators/Offerors Printed/Typed Name Signature - Month Day Year <br /> r �. <br /> J 16.International Shipments <br /> F- ❑Import to U.S. ❑Export from U.S. '/ Portof entry/exit <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> IX 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> 124 izc� <br /> y <br /> Transporter 2PdntedfTypgfName ��/ Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> QuanBty ❑Type L1 Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> C� <br /> LL Facifity's Phone: <br /> W 16c Signature of Aitemate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1• 2. 3 4 <br /> ire tib. <br /> zip, s:J <br /> 20.Designat d Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typedame Signa �� Month ;Day ear <br /> EPA Form 8700-22(R6"v.12-17)rPFeviol editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br /> Clean FlaMom has the approplate petr,3 .of of a unit wept the waste trie genemtor 1:3 srlpp+ng. W 2001385079-002 FPW <br />