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Rease print Cr e.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone1124136011J113K <br /> ffest Tracking Number <br /> WASTE MANIFEST CAL 0 0 0 3 3 0 4 2 3 1 ('8001424-9300 <br /> 5.Generator's Name and Maill Address Generator's Site Address(if different than mailing address) <br /> O&M A�►1 M INC D ACY CHEVROLET �t� � 3 2�� <br /> 3400 AUTO PLAZA WAY "n <br /> TRACY CA 95304 <br /> Generator's Phone: 203 8354500 r- <br /> 6.Transporter 1 Company Name `l.f ,"�EAL 6 <br /> ASUURY ENVIRONMENTAL SERWES JChVID2'#-2'7' 7 038 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> DEMENNO 1 KERDDON <br /> 2000 NORTH ALAMEDA STREET <br /> COMPTON tit 90222 <br /> Facility's Phone: (31LO1537-71.049 JCAT0600i3352 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> ' NON-,RCCA WARDOUSi WASTE,LIQUID(OILY WATERT 0 0 i TT O 223 <br /> 2. <br /> FOR RECYCLING/TREATMENTS AT THE M-�- <br /> F' FACILITY <br /> 3. CALIFORNIA.THIS FACILITY HAS THE NECLSSARY <br /> PERMITS TO RECEIVE YOUR WASTE STREAM AS <br /> 4. UUALIVILU.UOR EPA NUMbLLR IS=080013352 <br /> "�:, -: 14.,Spr3cialliandGng,krsW,Gbp4.@n. _(dotrpllr�fo7�tron.,�l - br :ta �.,,.3:..�.u;!'L.r.�'•r-�+•s.�rik9�'�b>.xb'�.'L'.�y srsr�er ,;_.•w J.w�x�,... a:>,,.ss:,:.���..',:::::.r.;._�: ,.ate*.s <br /> NAAERG# 8ft:X179. PROOILE 0981:A(>P*EMERGENCY CONTACT:CHEM REC 1000424-9,"0 <br /> (AUTOMOTIVE CLARIFIER PROGRAM APPROPRIATE PERSONAL PROTECTIVE EOU1PMENT <br /> t' V66 Awl/1 Z) /RQ y/-'1 <br /> 4 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fullyAnd accurately described above by the proper shipping name,and are classified,packaged, <br /> 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 <br /> Exporter,I certify that the contents of this consignment 6honn to the terms of the attached EPAAdcnowledgment of Consent. <br /> I certify that the waste minimizatpn statement identified In 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a sm II antity �ieretorj.is e.i <br /> Generatoes/011`4 Printed/Typed Na � Signature /� f Month Day Year <br /> i/� 6 r <br /> .J 16.,Intemational Shi ments <br /> ❑Import to U.S. ❑Export from U.S. Port 6f entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W17.Transporter Acknowledgment of Receipt of Materials <br /> I'- Transporter 1 Printed/T ame % Signature ! % Month Day Year <br /> 7 i <br /> 0. <br /> to Month Day Year <br /> Z Transporter 2 Pdnt /Typed Name Signatu /' <br /> Q <br /> tL' <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ C uanfity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 1 8b.Aitemate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> LL Facility's Phone: <br /> 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(Le,,codes for hazardous waste treatment,disposal,and recycling systems) <br /> O 1. ZI <br /> 2. 3• 4. <br /> 20.Designated Facility er or Operator: rt fication of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pdnted/Typed Name Signature T - Month �a Yeas <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />