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Please paint odtype (Form designed for use on elite(12-pitch)typewdler.) Form Approved.OMB.No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator lD Number - fie 1'of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000384370 i (800)42-1-9300 013085423 JJK <br /> S.Generator's Name and Mailing Address •i Geraniums Site Address(if different than mailing address) <br /> MARCH LANE SHELL-MAR654 <br /> 1206 E MARCH LANE <br /> STOChona 825 960-3797 95210 <br /> Generelels Phone: <br /> e.Transporter 1 Company Name U.S.EPA ID Number <br /> AS8URY ENVIRONMENTAL SERV;CES CAD 0 2 8 2 7 7 0 3 6 <br /> T.Transporter 2 Company Name US.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA IO Number <br /> ❑EME 9'0/ NERDOON <br /> 2000 N.ALAMEDA STREET <br /> COiMPTt,iN r CA 80222 CAT 0 8 0 013 3 8 <br /> FacllysPhone: (310}J 7-7100 <br /> 9, 9b.U.S.DOT Description(Inducing Proper Shipping Name,Flazard Class,ID Number, 10.Containers 11.Total 12:Unit <br /> and Packing Group(if any)) 13.Waste Codas <br /> No. Type Quantity WlA7ol. <br /> 0 1' NON-RCRA HAZARDOUS WASTE,U40ID(OILY WATER) D M — G 223 <br /> w <br /> Z <br /> w 2. - 'v .i <br /> 4. <br /> 14,Special Handling Insbucfions and AddlOonal Information <br /> E'MERGENCYCO,IT/kCT:CHEMI'REC 1-900-424.9300NAERG#981:171*PROFILE#983:05022014 OILY <br /> WAU/`/TER*PV)Aii0i85549*APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> rL/d <br /> 15. GENERATOR'SIOFFEROWS 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 Iabeled/placerded,and are In all respects in proper condition for transport according to applicable intema8onaland national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify[hat the contents of this consignment conform to the leans of the attached EPAAcknvdedgmenl of Consent <br /> I cedly that the wade minimization statement identified N 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(If I am a small quantity generator)Is true. <br /> Generafolsl0fferols Pdntedfryped Name Signature Month Day Year <br /> s IIW R AV/y r�W1 "�J—i d <br /> 16.International Shipments; <br /> ❑Impart b U.S. ❑Export from U.S. Pod ofenlryledt <br /> F <br /> Transporter signature(for exports only): Dale having U.S.: <br /> Of 17.Transporter Acknowledgment of Receipt of Materials <br /> Transpod!r, dntedlryped Name Signature - Month Day Year <br /> Z Trenaporter2Prinledflyped Name (_Signature Month Day Year <br /> r: <br /> 98.Discrepancy <br /> Its.Discrepancy ln&atlen Space ❑ Quantity ❑Type 11 Residue ❑pard Releclion ❑Full Relecllon <br /> Manifest Reference Number: <br /> tab.Alternate Facility(or Generator) - U.S.EPA ID Plumber <br /> J <br /> U <br /> LL Fadlilys Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal.and recycling systems) <br /> O 1{ o q 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Cartifia6on of receipt of hazardous materials covered by the manifest except as acted in Item 16a <br /> VIII' Pdnied/Typed Namen Sgnalum Month Day Year <br /> /4n QYt,-) <br /> EPA Form 8700-22(Rev.3-05) Previous edliohsamobsolete. DESIGNATED FABI O G NERATOR STATE(IF REQUHSED) <br />