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Please print or type. (Farm designed for use on elite (1241ti ii' neviriter,) Form ADDroved_ OMB Na- 2050-0039 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST CAL000316754 559 -277 -IM I al g o nm% JJ K 5. Gsneralor's Name artd Mailing Address Generators Site Address (if different than mailing address) Pacific Lthinol Stockton LLC 3028 Navy Drive Stockton, CA 96206 209-851-4073 GsnerMor`5 Phone: 6. Transporter 1 Company Name U.S. EPA ID Number All Valley Disposal, Inc. CAROM 81 NG 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number Crosby & Overton 1630 west 17fst street Facility's PhoneLong beach, CA 90813 682-432-M45 C:AM2840W)19 9a, 91b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit HM and Packing Group (if any)) Quantity Wt.Nol. 13. Waste Codes No. Type UN2914, Waste., @amallaUe liquid, corrosive: n,o s„ (methanol ~ and rNorclform), 3, .PGH ( 0001 D002 027 W W z. CD 3. 4. 14. Special Handling Instructions and Additional Information o,.i) CWomat A profile 104210 ERG 134 9b.3) 9b.2) 9b.4j 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, 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) (if I am a small quantity generator) is true. GeneratorslOfferor's Printedfryped Name Signature Month Day Year J Z 16, International Shipments ❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: - Transporter signature (for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 Phrriedlffyped Name Signalure Month Day Year O IL QTransporter 2 PrinWdlTyped Name Signature Month Day Year F 18. Discrepancy 18a. Discrepancy Indication Space Quantity ❑Type El 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) LLI C3 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 Printedfryped Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY