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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator IDNumber 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST -024184522 JJ K 5.Generators Name and Mailing Address i u -'O'ON Generator's Site Address(if different than mailing address) t'.st !t ii`r' i3i:�9 tlf;j 28320 I*,RIVER RD _ E 3(;AE,()N.C-A 9',S32')' Generator's Phone-6 6.Transporter 1 Company Name U.S.EPA ID Number +IV}F_t;tC PdK VALLEY Vi1A,5VE OIL, C AR(M211'302 7.Transporter 2 Company Name U.S.EPA ID Number �`K.t-2 i-11,NIkk ftE 4;OVERY SYS I-EMZN:tl K' :;:'t;l is tis 115-14 2 8.Designated Facility Name and Site Address U.S.EPA ID Number Yt�fA�lA l''#5 2 LitAw7i: Ilttitd:it��2 FAi�ILIFY AZK9305.21146 Facility's Phone: '' +°i z•,' ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity WL/Vol. 13.Waste Codes 1' t kki-'.ic` A i•Ifi'Af>tNAN-VJA.I<tf- 4Cll,tf l AA,%(1F K NT<; 1,rAPFR oil .`.,.< t'�t}.�tl"tTtv�i F?�EiIRt'� 4 Z 2. LU t9 — 3. 4. 14.Special Handling Instructions and Additional Information V'tt,(F'tl..E#'Z",—)MNR6 OWER FRA EIRE EI G#I/I FtV1k F2L3FN{;Y{<C�IIA{:I' It FiRY 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,arra 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,l 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)(ifl am a small quantity generator)is true. Generator's/Offerors Printedrryped Name Signature Month Day Year 16.International Shipments ~ ❑Import to U.S. ❑Export from U.S. Port of entrylexit Z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LLI oTransporter 1 PrintedrTyped Name. %" Sgn#r fi' / ` f) Month Day Year Z Transporter 2 Printed/Typed Name Signature Month 'Day Year f- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. >' 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V ti Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z — -- -- - _ 0 19.Hazardous Waste Report Management Method Codes p.e.,codes for hazardous waste treatment,disposal,and recycling systems) Notice: State of California re ui res 0 1. z. 3. generator to photocopy and mail to DTSC with 30 days: 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a P 0 BOX 400 PrintedrTyped Name Signature 11 1 Sacramento, CA 95812-0400 EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY