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In Please print or type. Fort Approved, OMB No. 50.0039 UNIFORM HAZARDOUS 1 . Generalor ID Number 2. Page i of 3. Emergency Response Phone . Manifest Tracking Number WASTE MANIFEST ILR000130062 1 800.424-9300 J-022651492 JJK 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) Heritage - Crystal Clean , LLC Heritage - Crystal Clean , LLC 2175 Point Biva , Ste 3754370 Absoiut Avenue Elgin , IL 60123 977-93x3-7945 Fresno, CA 93725 Generator's Phone: 6. Transporter 1 Company Name U.S. EPA ID Number Heritage - Crystal Clean , LLC ILR0Q0130062 7. Transporter 2 Company Name U.S. EPA ID Number i 8. Designated Facility Name and Site Address U.S. EPA ID Number World ail- San 'Joaquin, LLC 11297 E. Manning Ave FacilityPhone: I�ariier, CA 93648 559.4W0240 CAL000 .102701 ' 's 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)) 13. Waste Codes No. Type Quantity WWNoI. 1 . t F lion RCRA Hazardous Waste, Liquid , (used oil i mixed ail t TT 63 G 221 ' LU 2 w 0 3. 4. 14, SpecialHbn11) USef UIIdKC1 ! 1 f 7 ban b.3 Di►. ) b.4) , i 15. GENERATOR'S10FFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and a=ralefy described above by the proper shipping name, and are class8lad, packaged, marked and labelediplacarded, 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 allached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 282.27(a) (if I am a large quantity generator) or (b) (III am a srVI quantity generator) is [woo ane or Offerors PrinledfTyped a Sig Month Day Year lie to 0 j j 16. International Shipments i- Import to U.S. ❑ Export from U.S. Port of entrylexit ? Transporter signature (for exports only); - to leaving U.S.: W 17. TransporterArknowiedgmenlofReceipt ofMaterials �- ran er 1 Pdntedfiyped Name Month Day Year on Q! Transporter TPrIntedfTyped Name sign0re Month Day Year r- 18. Discrepancy 18a. Discrepancy Indication Space goantity ❑ Type ❑ Residue ❑ Partial Rejectlon ❑ Full Rejection Manifest Reference Number. 18b. Alternate Facility (or Generator) U.S. EPA ID Number C:1 _ Facility's Phone: W 18c Signature of Alternate Facility (orGenerator) Month Day Year i 19. Hazardous Waste Report Management Method Codes (f.o., codes for hazardous waste treatment, disposal, and recycling systems) 0 1 • 2. 3. 4. 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedfTyped Name Signature Month Day Year EPA Farm 87M22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e4ANIFEST SYSTEM