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4P 11,904827674-00-1 K. PPW 7!i2/2018 <br /> le ase print or type.(Form designed for use on elite(12-pitch)typewriter.) 2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WAS��TttE��MANIFEST /ad�5�0 0 i (SDQ�453-3715 1011848923 FLE <br /> 5MOumnt n FI use YYatets t reatment Plant Generators S leAddress(ii different than mailing address) <br /> 19045 Kelso Road SAME <br /> Mountain"15811 <br /> Generators Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Clean Harbors Environmental Services.Inc. MAD 0 3 5'3 2 2 2 5 0 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Desig early and SdeAddress BAU.S.EPA ID Number <br /> itERSFIELDTRANSFER t`% Lir (i v 28 2 a 3 0 <br /> 1620 E.BRUNDAGE LANE <br /> Bakersfield.CA 93307 <br /> Facir s Phone: (66i1322-9259 <br /> 9, 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM <br /> and Packing Group(d any)) No. Type Quantity WtNol. 13.Waste Codes <br /> 1NON-RCRA HAZARDOUS WASTE,LIQUIDS,(DESEL,WATERT 343 <br /> M <br /> z 2. <br /> W <br /> C9 <br /> 3. <br /> 4. <br /> t4_S gaodLrg",-WW Additional Information <br /> ;icntract retained by venerator confers acency mllyhority on initial tranaco�zer t0 add ur 5uD,-,VMe addlVonal tmnsoorters or, roeriera*m-1f,henait <br /> 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, <br /> marked and labek:drplacarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.H export shipment and I am the Prtmary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknovAedgment of Consent. <br /> 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. <br /> to sn meSignature on ay ear <br /> n-1,�6ct- hG iv <br /> 16.International Shipments <br /> H ❑import A.S. Export from U.S. Port of entrylexit: <br /> = <br /> Transporter soiature for ex onl Date leaving U.S.: <br /> tY 17.Transporter Acknowledgment of Receipt of Materials <br /> 72�!�1 PrintediTyped Name 5 na re ser <br /> y +"� cmc Lyes o 1.&YIT <br /> a Transporter 2 Printed/Typed Name SignatureYM <br /> mom W <br /> a' r <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Fu Re ,o, <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> Q <br /> W FecAlis Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> US19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1. q 2. 3. 4. <br /> Hl1 <br /> 20.Designated Facility Owner or Operator.Caffai8on of receipt of hazardous materials covered by the married except as noted in Item 18a <br /> TypedName Signa Month Day Year <br /> 1r v <br /> EPA Form 8700-22(Rev.3-05) Pr vious eclitimrare obsolete. 6XI DW61NATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />