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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 Phone 4.Manifest Tracking Number WASTE MANIFEST CAI- 000 358 781 --241A 1014794448 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if di event than mailing address) Grantliine Shell 14550 N Benson pare STE A 2375 W Grant Line Rd Gen :CA 91786 909456-2009 TracV, CA 95377 6.Transporter 1 Company Name U.S.EPA ID Number Big Sky Environmental Solutions CAL 000 346 010 7.Transporter 2 Company Name U.S.EPA ID Numbep'1A- f(G Zl -,, jq-1 8. 8.Designated Facility Name and Site Address U.S.EPA ID Numbers y Crosby&Overton CAD 028 409 019 1630 West 17th St FahIg0g,�ac;h, CA 90913 800-827-6729 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, r 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol, o RO, LIN 1€193,Waste Flammable Liquid,N.O.S., 3, PG III r) .J' d00.1..J_D0.18_;, (Benzene) (RQ 'Doo1) Z 2. i W 3. 4. I 14,Special Handling Instructions and Additional Information Wear PPC' ERG 152, Profile 8b1 �- Emergency Contact, Jeff Rhodes 510-541-2128 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 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)(ifI am a small quantity generator)is true. Generator'slOfferor's Printed/Typed Name � �� Signature � Montly Day Year S (JA/�\ e _j 16.International Shipments ❑Import to U.S. Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17,Transporter Acknowledgment of Receipt of Materials UJ Transporter 1 Printed/Typed Name Signature Month Da� Year a � co Z Trans er 2 Printed/Typed Name Signature Month Day Y r 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantityyp 1 ElT e ❑Residue El Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U uQ- Facility's Phone: LU 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. / 2. 3. 4. 20.Designate Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped me Signature /y Month Day Year EPA Form 8700-2 (Rev.12-17) Previous editions are obsolete. 'DESIG ATED FACILITY TO EPA's e-MANIFEST SYSTEM