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t; <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator lO Number 2.Pagetof 3Emergency Response PMne d.Manifest Tracking Number <br /> WASTE MANIFEST C A D 9 8 2 3 5 6 9 4 1 1 900 474-9300 1 008138016 JJ K <br /> 5.Generetols Name and Mall Address Generetols Site Address(if different than paling address) <br /> WAMCRANE WOM <br /> PO BOX 999 2373 M4RIPOSA ROAD <br /> LA PORTE TX 77572 TOCKTON CA 95205 <br /> Generators Phone: <br /> 6,Transporter 1 Company Name U.S.EPA ID Number <br /> SERVICE C A D 0 2 8 2 7 7 0 3 6 ' <br /> 7.Transporter 2 Company Name U.S.EVA IO Number <br /> e.Designated Facility Name and Site Address U.S.EPA 10 Number <br /> SIEKM INDUSTRY,INC. <br /> 5375 SOUTH BOYLE AVENUE C A D 0 9 7 0 3 0 9 9 3 <br /> LOS ANG <br /> _ CA 90058 <br /> - FadI16Ja Phone M312MIM0 .......... <br /> gy 9b.U.S.DOT Description including Proper Shippl g Name,Harard Class,l0 Number, 10.Containers 11.Total 12.Unit 17 Waste Codes ' <br /> HM and Pal Group(If any)) No. Type Quantity WNs. I; <br /> 112 <br /> NON•RCRA HAZARDOUS WASTE,SOLID(OILY SOLIDS) <br /> i 2. i <br /> w <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Information . �O <br /> EWRGENCY CONTACT'.CHEMTREC 1-800-424-9300 NAERO# 1 : 1 O LE#9B1 :APIOI 169 OILY SOLIDS, <br /> ABSORBENT,SWEEP'POO Al 101140944'APPROPRIATE PERSONAL TECnVE EQUIPMENT IV/ 3 5-3 R&3 <br /> 15. GENERATOR'SiGITEROR'S CERTIFICATION:I hereby declare Mat the contents of this consignment are"Y and accumlelydasalbedabove by the proper shipping name,ardareclassified.pecNeged, <br /> marked and labeladlplamned,and are mall respects In proper conlition for transport according re applicable mtemaeonalald national governmental regulerions.If export shipment and l am he Primary i <br /> Exporter.I certify that the contents of Ws consignment conform to the terms of the attached EPAAdmowledgment of Corsair. <br /> I mdry that the waste minimization statement identifad in 40 CFR 2622generator 7(a)(if I am a large quantity geator)or b)(if I am a small quantity generator)is tare. <br /> s/OOeroes P rtedR Name Si W �^ n Y r <br /> 4 <br /> F 16.Inlematonal Shipments ❑Impodto U.S. ❑ExPOd hop U.S. Pod ofentryledt: <br /> Z Transporter Antuna(for exports only): Data leaving U.S.: <br /> C 17.TrarepoderAcknowledgment of Real ofMatedals <br /> W. Tran PrintedRyped Name Signa da <br /> 0 6�J{� <br /> Z Trans r2 Pdnted/T am re - month Oy Year <br /> t15.01screpancy <br /> 18a.Discrepancy Indication Space ❑ Call ❑Type ❑Residue El Partial Rejection ❑Full Rejedbn <br /> Manifest Referenca Number: <br /> 106.Altemale Fealty(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Fadllys Phare: <br /> 10c.SlgnatumofAilemate Fadity(or Generator) Month Day Year <br /> 19.Hazardous 14ast. Management Matlntl Codes I.e.,codes forharardous waste aealm l disposal,and recycling systems) <br /> 0 1' 2. <br /> 3. 4. <br /> 20.Oealgneted FWAY Qvnar oro .Down ion ofreceipl of Nou osimas covered by the rtanifestexospt as noted in <br /> eros Slgnature Month y Year <br /> EPAForm8700-22(Rev.3-05) Previouseditions are obsolete. DESIGNATE ACILITYTOD STINATIONSTATE(IFREQUIRED) <br />