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Ple se print or type.(Form designed for use on elite It 2-pitch)typewriter.) 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 A L 0 0 0 3 3 0 4 2 3 aOO)424.9aC1U I AiJ3 JJ K 5 Generator's Name and Maill ss A Generators Site Address(if different than mailing address) TRACY CHEV . &M INC 3400 AUTO PLAZA W Y :=h� °t. � TRACY CA 95304 f „ ate t Generators Phone: 6.Transporter 1 CompanyName U.S.EPA ID Number '11PONMENTA!SERVICES ��R ` `� I 7.Transporter 2 Company Name )` �1 S.EPA ID Number 8 Designated Facility Name and Site Address U.S.EPA ID Number 2000 N ALAMEDA STREET --oMPTONCA ;,0�1 4 i u b o 01 Facility's Phone: 13101531-710 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity WI Nol- 13.Waste Codes 1' .,N1993 'WAST E FLAMMABLE :_QWO. N (GASOLINE. DIES i.).3 D001 0018 343 0 PG II r, r Z 2. tir L7 i 3. 4. 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT CHEMTREC 1-800-424-9300 NAFRs"7n 981 128 PROFILE N 9B1 365874 GASOLINE. DIESEL * ` APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT 7 17 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.I(expon 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. Generators/OforePrmtWypedName Signature Month Day Year ri 16.International Shipments F- ❑Import to U.S. ❑Export from U.S. _ Port of entry/exit z Transporter signature(for exports only): Date leaving U.S.: 10: 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printedrryped Name r Signature -;r Month Day Year d I — —� aTransporter 2 Prin edfTyped Name Signature Month Day Year 18,Discrepancy 18a.Discrepancy Indication Space ❑ Quantityyp ) j ❑Type ❑Residue ❑Partial Re ectian ❑Full Rejection Manifest Reference Number: 18b,Ntemate Facility(or Generator) U.S.EPA ID Number U LL Facility's Phone: w 18c.Signature of Attemate Facility(or Generator) Month Day Year i Q z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1.j ' 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 i Printed/Typed Name Sgnatu Month Day Year �� ILLA U EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGN TED FACILITY TO GENERATOR STATE(IF REQUIRED)