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Please pA or type.(Form designed for use on elite(12-pitop)typewrite4 jgk4{2767 - p 7112/20-j%2; - 8 039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Plane 4.ManhM Tracking Number WASTE MANIFEST 7 I 1011848922 FLE 5.Generator's Name and Mailing Address ne2tof§S e ress( than malling address) Mountain P'luse Water Trsa!m' ?»t Pln it 18045 Kelso road SAt'S!F 1Ge Hn a'Os !ii timet� 6.Transporter 1 Company Name U.S.EPA ID Number Clean Harmers i=naironf'wrral Sef-+ices.Inc. 4 -? 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number COLES ENVIRONMENTAL/BAKERSFIELD TRANSFER C A i 0 0 0 2 8 2 v 8 8 1620 E.BRUNDAGE LANE id.CA 93307 _ ga 9b.U.S.DOT Desaig udngroper rpping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit HM and Packing Group(d any)) No. Type Quantity Wt.Nol. 13.Waste Codes 1. o NON-R+CRA HAZARDOUS WASTE:LIQUIDS.IDESEL,WATERI Z 2. LU 3. 4. i 131,E I�tructions and 2—IYTI Additional information W 1�tot�5a I C7ntr30't retanled bu aerie-ator COrrisrs 3CenCY autttortty On Initlal transCOrter to add or substnute additional trzinspoler5 or, aener=lsf 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedare 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 ooniants of this consignment conform to the terms of the attached EPAAcknowledgment of Consent I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or (I I am a small quantity generator)is true. S y ameVVture Month Day Yew v r 16.International Shipments t• Import to U.S. Export from U.S. Port of entry/exit z Transporter signature for exports only): Date leaving U.S.: 17.Trareporter Admowiedgrnent of Receipt of Mauls Hors 1 Prirted/Typed Name ay dearr IL trrV� %XW e,% Iva t 0 zTransporter 2 PrinlaCyped Name gnahrre y Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number V LLFadlRys Phone: 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recydhg systems) C 1. 2. r T.L 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted m hem 1 as Pri hdTyped Name S gnatu Month Day Year 1 1$ EPA Form 8700-22(Rev. 5) Previous editions are obsolete. 'DESIGNKID FACILITY TO DESTINATION STATE(IF REQUIRED)