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Please print or type Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 1 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST I CA L 0 0 0 4 0 7 0 3 0 1 510-562-61$1 024550259 JJ K 5.Generators Name and Mailing A^'dre:•- Att Tom Robins Generalues Sita Address(If different[ten mailing address) United#5447 United#5447 4130 Cover Street 1489 E Hammer LN Long Beach CA 90808 Stockton CA 96210 Generators Phone: 6-Transporter 1 Company Name U.S.EPA ID Number Bayview Industrial Services, Inc ICA R 0 0 0 3 4 7 4 9 2 7,Transporter 2 Company Name U.S.EPA ID Number All Clean Hazardous Waste Removal Inc C A 9 8 2 4 9 2 3 9 9 8.Designated Facility Name and Site Address U.S.EPA ID Number US Ecology Nevada Highway 95, 11 South of Beatty Beatty NV 09003 Facility's Phone: 800 239-3943 IN V T 3 3 0 0 1 0 0 0 0 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 an No. Type Quantity Wt.Nol. 13.Waste Codes 1-UN 1325,WASTE Flammable solids,organic,n.o.s. O© � I❑001 ❑O18 352 o X (Gasoline)4.1,PGII too OM P z 2 w c7 3- 4 14-S Cial Handling Instructions and Additional Infofmahon Debris impacted with gasoline.Profile#070316587-0. ERG#133 Invoice disposal to Bayview Industrial Job#22806. CGRS# 23171.5. 15. GENERATOR'S/OFFEROR'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 internationaland 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 (if I am a small quantity generator)is true. GeneratorVgfferaes Printedl Name Signatures Month Day Year c col L r--1, A. I L 123 16,Inlernatianal Shipmerft F— [71 Import to U.S. ❑Export from U.S. Port of entry/exit: Z Transporter srgnatufo(for exports only)- Date leaving U.S: W 17.Transporter Acknowledgment of Receipt of Materials IY Transporter 1 Pr ntedrryped Name Signature Month Day Year a Nick Cleveland rL�L 0 7 11 2 P 3 z Transporter 2 Printed/Typed Name Signature Month Day Year 111A t ckefe I C, 4ac ;56&]i Q1 07 118 Z.3 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue j j Partial Re ection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S-EPA 10 Number J_ V u<- Facility's Phone: w 18e-Signalum of Altemate Facility(or Genera(or) Month Day Year ~a z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 1 ' 2 3. 4. 1�1 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pii,dLLVTy Jdiac Signature 1411oft Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM