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Pleaseor rint '`` p type �:;� Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1'.Generator ID Numberage 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST e- A L�3Lo+�'r� 2.P 1000-424-9300 1 1 016'571862 FLE 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) 7-E1even; Inc: P.O. Sou 80741 32bz v1 Rancho $sats 1Rrgarita, CX 9RIES Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number CAt000103913 7.Transporter 2 Company Name U.S.EPA ID Number '8:Designated Facility Name and Site Address U.S.EPA ID Number 6d Oil^Reclip CA=090013301 tt2 (310) 537-7100 Fad V Phone: 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.N01. o K 1. 0111203, f sQU"a Mixture, 3, PQ II 134 l -za 6 X 2. LU 3., 4. 14.Special Handling Instructions and Additional Information 1m ALL ArI1t21 UweI 1 f t 188 pAp?Rf'!$IIR C1d9l11>7!f{ aaeollt+N i 14tas 7-i] C(�: 61371 A LX�S 15. GENERATOR'SfOFFEROR'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)(ill am a small quantity generator)is true. Generators/Offerors Printed/Typed Name Signature Month Day. Year Tarry *"thart of =41 an babW ot.""rator J 16.International Shipments 0 Import to U.S. ❑Export from U.S. Port of e x Z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LU Transporter 1 Printed/Typed Name Signature Month Day Year z Transporter 2 PrintedlTyped Name Signature Month Day Year F 18.Discrepancy 18a.Discrepancy Indication Space El Quantity ❑Typej j ❑Residue Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID.Number. J V LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. to�3c 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name ii Signature pgth Day Year 1 ?1 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. TRANSPORTER COPY