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Please print or type.(Form designed for use on elite(12-pitcl. m—'.) G8366292"02 Sc"W WIT Form Approved.OMB No.2050-0039 <br /> =Generator 2.Page 1 of 3.Emergency Response Phone 4.ManOifesOt Tracking NumOber �� FLEUNIFORM HAZARDO3 9 9 7WASTE MANIFEST 864 �8 7i8 <br /> 5.Generator's Name and Mailing Address Generator's Site Address if different than mailing address) <br /> Ttasoro Refining&Marketing Company SAME <br /> 3003 Navy Drive <br /> Stoddon,CA 96206 <br /> Generator's Phone: 209 466-8800 U.S.EPA ID Number <br /> 6.Transporter 1 Company Name <br /> CI@ln I�9 rV4€_Mf0M �€ I S IIS M A C!O 3 9 2 2 <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> fl <br /> "oft -it Buftirm11m LLC CAD980100750276 <br /> 2600 west LoksrnRoad <br /> t �nwillow,CA 93206 <br /> Facirtys one: _ <br /> P.2 620-0 <br /> 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> 9a. No T Quantity Wt.Nol. <br /> HM and Packing Group(if any)) yPe <br /> I I <br /> 0T2. <br /> ON RCRA HAZ RDOIUS WASTE SOLIDS,(DIESEL) ®\ C yd5 <br /> s <br /> a <br /> Cr <br /> z <br /> UJ <br /> 3. <br /> I <br /> 4. <br /> c�IPSPI Sot <br /> Io0a 2-- <br /> I <br /> 14.Special Handling Instructions and Additional Information <br /> 1.CH4719S3B <br /> 15. GENERATOR'SIOFFEROR'S CERTh shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in ations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this cor. <br /> I certify that the waste minimization statement io, or)is we. <br /> Month ay Year <br /> Generatoesl0fferoes PrintedlTyped Name <br /> -I 16.International Shipments1-1 Import to U.S. ,'!exit: <br /> F <br /> Z <br /> Transporter signature for exports only): <br /> avin U.S.: <br /> X 17.Transporter Acknowledgment of Receipt of Materials <br /> on Day Year <br /> Transporter 1 Printed/Type(d Naamme r S Ip�rntI 1� <br /> a �J lMoonthh Day Year <br /> QTransporter 2 PrintedrTyped Name <br /> PC <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> U.S.EPA ID Number <br /> 18b.Alternate Facility(or Generator) <br /> J_ <br /> V <br /> ra+ Facili 's Phone: Month Day Year <br /> C3 18c.Signature of Alternate Facility(or Generator) <br /> w <br /> a <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1 2. 3. 4. <br /> H132 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Month Day Year <br /> PrintedrTyped Name Signature <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> fl___"_rhrw harp th,o nnmmnrir*A nwrmiln for and will semot the vAsste the generator is shionind_ <br />