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Please print or type.(Form designed for use on elite(12-pitch)ty)ewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number WASTE MANIFEST CAL 0 0 018 2 6 4 5 1 (800)424-9300 Q 7 4 6 8 3 41 JJ K 5.GenerAtKWW M#aj 4i dress Generator's Site Address(if different than mailing address) 500 E_KETTLEMAN RD. LODI CA 95240 Generators Phone: 209 339-0900 6.Transporter 1 Company Name U.S.EPA ID Number ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number ASBURY ENVIRONMENTAL SERVICE-CERES 1920 MORGAN RD. CERES CA 95358 CAL000393680 Facility's Phone: (209)541-1825 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HU and Pacldng Group(if any)) No. Type Quantity WUoV1. 13.Waste Codes 0 1. NON-RCRA HAZARDOUS WASTE, LIQUID(OILY WATER) 223 001 TT G z 2 LM t t 3. 4. 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT*EMERGENCY CONTACT CHEMTREC 800-424-9300 *TRUCK fit► 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, madded 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 EPAAcknovdedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(d I am a large quantity generator)or(b)(d I am a small quantity generator)is true. GeneraloeslOfferor;F''tedrfyped Name Sig Mo Day Y11161e % _r 16.International Shipments L1 Export from U.S. Port of en /exit: j— Ll Import to U.S. try z Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials OTransporter 1 Printed!) Name Signaturet D Y a G b QTransporter 2 Printed/Typed Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Spaceuanfity ❑/Type ❑Residue El Partial Rejection ❑Full Rejection 23 a!l'p Manifest Reference Number: 18b.Allemale Facility(or Generator) U.S.EPA ID Number U LL. Facility's Plane: w 18c.Signature ofAltemate Facility(or Generator) Month Day Year Q Z NLLJ 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2. 3T— ca 01 20.Designated Facil y Owner or Operator.Certification of receipt of hazardous matenals covered by the manifest except as noted in Item 18a Printedrfyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous eddons are obsolete. DESIGN D FACILITY TO DESTINATION STATE(IF REQUIRED)