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Please print or type.(Form designed for use on elite(12-pitch}typewriter.) Form Approved.Ol No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of Fl.Emergency Response Phone 4.Manifest Tracking Number i U:ASTE HIANIFEST 364 610 t JJ�[I\ 5.Generators Name and Mailing Address Generator's Site Address(it different than mailing address) ABC Tran8m3ssiOT'. b"lc . i 193 S. ti mon Rd. ll:an eca, CA 95337 Generators Phone: ? "918-265.0 6.Transporter 1 Company Name U.S.EPA ID Number SACRAMENTO WASTE OIL 7.Transporter 2 Company Name U.S.EPA ID Number 0.Designated Facility Name and Site Address U.S.EPA ID Number 6500 S US Highway 45, Yuma , Arizona 85365 Faci[itysPhone: 928-344-982 v` go 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 Na. Type Quantity WiNol. o NL ON-RCCA HAZARDOUS WASTE SOLIDS (0117 Solids) w i 3. t 4. t 14.Special Handling Instructions and Additional Information AND USE PPE 15. GENERATOR'S10FFEROR'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 Iabeledfplacarded,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 EPAAcknowiedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 21(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true_ Generato{s/Offerors PdntedlTyped Name Signature Month Day Year I 16.International Shipments Z ❑Import to U.S. ❑Export from U.S. Port of entrylexif: -- Transporter signature(for exports only): Date leaving U.5-: 17.Transporter Ackrowledgment of Receipt of Materials LU I'–Ill Transporter 1 Printedffyped Name Signature Month Day Year QTransporter 2 PrintedlTyped Name Signature Month Day Year t- 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: } 18b.AlternateFacilit or Generator � y{ } U.S.EPA ID Number J U LL- Facility's Phone: C1 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) 1. 2. 3. 4. 20.Designated Faclity Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedrfyped Name Signature Month Day Year EPA Form 8700-22(Ray.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY i