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Please print or type.(Form designed for usa._'on slits(12•pitch)typewriter) a d;:;. -`` 'n Form Approved.OMB No,2050.0039 <br /> UNIFORM HAZARDOUS 1 C'enera(or ID Number Amerge Response Phone 4.Manifest Tracking Number :» �/ <br /> WASTE MANIFEST. -:QrO 2 .S 5 G ",v2m `.. MOO)42 -9.'s0O .,``. 10 5�`�0"6 J w JJ K <br /> 5.Generators Name and aI`9 4 �: ,; Generators Site Address IV different than mailing address) <br /> ;Ess REFiNI��a'�1 � •., <br /> STOCKTO Cli4IRAve . CA 95255 <br /> GeneraiWs PMne. <br /> B.Tran - U.S.EPA ID Number <br /> W10, hONMENTAL SER410ES ChD 0 2 8 2 7 7 0 3 a" <br /> '7.Transponer 2 Company Nemo U.S.EPA ID Number <br /> 8.OesignaDdica NNgeanStAdd1,et@ U.S.EPA ID Number <br /> 2005 K ALAMFDA STREET" t-', <br /> COMPTON ; CA -: 902-02 e Fr T 5w�4 C?S.�;3 FS c. <br /> Fadll s Phone: { -D}§2�nT"T1QQ <br /> ga_ 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Conlelners 11.Tetat 12.Unit 13.Waste Codes <br /> HM and Packing Group lir any)) " No, pa Quantity WWoi. <br /> NOI HAZARDOUS WASTE,LIQUID(ETHYLENE QLYCOI, 533 <br /> SOLUTICINS) <br /> w <br /> z z. <br /> w <br /> 4. <br /> E. <br /> 14.Speual Handling In§budlons and Additional Information <br /> EMERGENCY CONTACT:CHEMI RFC 1.800.4244 9300 NAERGN 9s1:sT1 Poi?FIEE 4 155 :553541 ETHYLENE GLYCOL <br /> SC) TlONS* *APPROPRIATE PERSONAL PROTECTIVE EQUIPM ENT I ., <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION; I hereby declare that the contems of this conslgnmentare lly anciaduulely 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 epplka�l0 inter akingandrdigonal governmental regulators,If export shipment and I am the Primary <br /> Expo(Yer,I oeNPy that the contents of this consignment conform to the lerms of the attached EPAAdmuwledgment of Cp ?..:r.� <br /> I WAdiatthe waste minlmizaton statement Identified In 40 CFR 282.27(x)(if l am a large quantity generator)ot(b' 8 iimo qu9n8tyggemtor <br /> Generek2slOfferm's Printed/Typed Namely -g7 nth Oyay Yeer <br /> F 16.International Shipments ❑Import to U.S. <br /> ❑Export from U.S- r 'Pod ofenby/aril: <br /> M Transporter signature(for exports only): Data leaving U.S.: <br /> w 17.TrenspoderAduwwledgment of Receipt of Materials <br /> Transpo I PrinhaFT petl Nartre SgneWre .>'` / Monti bay /Y/der <br /> O r-5.v" G'•+f9` 3 "°'�'v S�PtiUB�.s eco �...: P, ," w:;r+�...�,. �`6 .rCHt t VJ <br /> yZ Transporter 2 PrintedRyped Name ` ' aWm Month Day Year <br /> j18.Discrepancy �> <br /> fee.Dlitempancy Indication Space EJQwntity gpe V r t due ❑Peru Relectlon ❑Full Relector <br /> r` <br /> �A Manifest Raferenca Number: <br /> 18b.Alternate Fadllty(or Generator) - U.S.EPA ID Number <br /> J <br /> LL Fecllitys Phoria: ENVIRONMENTAL I-IUXTH p <br /> I <br /> W 181 Spidare olAllenate Faclllly(or Generalor) — Month Day Year <br /> Q <br /> Z <br /> W 19.Hazardous Waste Report Managemid Method Coda(Le.,codes for hazardous waste treatment,disposal,and'recycling systems) <br /> 20,Designated FadNy Ovmer a Operator Cerdficaton of=t ofh4afdona materials covered by the manges[except as noted In Nem <br /> Pri dRyped Nemo f Signature .�' Month, ayJ ea/fr. <br /> ��, EPA'Form8700-22(Rev.3-06) Previous adifionsare obsolete. DESPAATEDFACL. OGENERATOR STATE(IF REQUIRED) <br />