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rf . Farm roved.OMB.No.2050.0039 <br /> Please pFint orflyPe> designed for use on elite(12-pitch typewriter. . - APP <br /> UNIFORM HAZARDOUS 1.Generator lD Number e]'of 3.Emergency Response Phone 4.ManlfestTracking Number <br /> WASTE MANIFESTC A L O O p 3 8 4 3 7 0 i {800}424-9300 n 13 0 8 5 4 2 3 JJ K <br /> 5.Generators Name end Mailing Address Generator's Site Address(if different than mailing address) <br /> MARCH LANE SHELL-MAR654 <br /> 3206 E MARCH LANE <br /> STOCKTON 1 8259603797 CA 90210 <br /> Generators Phony <br /> 6.Transporter 1 Company Name - U.S.EPAID Number <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> C;E7dci--9j0/ KERECON <br /> 200 N.ALAVVIEDA STREET <br /> COMPTON CA 90222 C A T O 8 0 013 3 5 2 <br /> Fac9iV.Phme: (3'i01537-7i00 <br /> go, 91b.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(i(any)) No, Type Quantity WUVeI. <br /> 0 NON 3iCRP HAZARDOUS WASTE,LIQUID(OILY WATER) � D M„ J Ji 223 <br /> Cr7z <br /> 3. ...•.AUG 19 ZOIC , <br /> 4 ENVIRONMENTAL HEALTH ' <br /> 017PARTMENT <br /> 14.Special Handling InsNrctioru andAddltional Information <br /> EMERGENCY CONTACT :CliENITREC i-SOM24-9300 NAERG#SBi:i7i*PRORLE R 981:05022Oi4 OILY <br /> `NATER*PONA1iOiS5348*APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> o rise d,-t- <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare Nal the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplaurded,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 cediy that the contents of this consignment conform to the is=of Ne attached EPA Acknowledgment of Consent. <br /> I candy that the waste min inizabon statement identified In 40 CFR 262.27(a)of I am a large quantity generator)or(b)Off am a small quantity,generator)is true. <br /> Genemtoesl0lferoes Pdnted/ryped Name Signature Month Day Year <br /> (llSwo Sfj.9rK/v'// _ Iry <br /> F16.International Shpmenls ❑Impost to U.S v ❑Export from U.S. Pod afenlry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.TransporterAckwwledgmenl of Receipt of Materials <br /> 12 Tramporter Tt.sdriledryyped Name � � / Signature / Month Day Year <br /> Z Transporter 2 PriatedRyped Name Month Day Year <br /> a <br /> s <br /> r- <br /> 4. 18.Discrepancy <br /> tea.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) - U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 18c.Signature ofAllernale Facility(or Generator) Manlh Day Year <br /> a <br /> Z <br /> CD <br /> 19.Hazardous <br /> Waste Report Management Method Codes(i.e.,codes for hazardous waste Vestment,disposal,and recycling systems) <br /> 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Cer ificagon of receipt of hazardous materials covered by the manifest except as noted in Item Its <br /> Prmted/Typed Nam a Signature Mail Day Year <br /> CYC-? <br /> EPA Form 0700-22(Rev.3-05) Previous ediilamobsolete. DESIGNATED FAEI Y O GENERATOR STATE(IF REOUIF{ED) <br />