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w <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 <br /> ' 41FORM HAZARDOUS 1.Generator ID Number *>' :pa i of .Emergency Response Phone 4.Manifest Tracking Number <br /> TASTE MANIFEST CAR 0 0 0 216 5 516 1' %`(800)4249300 010 963480 JJ K <br /> 5.Generator's Name and Mailing Address - Generators Site Address(ff different Than mailing address) <br /> ECS REFINING LLC-ECS001 <br /> 2222 S SINCLAIR AVE <br /> STOCKTON CA 95215 <br /> Generators Phone: 209 7/4-5000 <br /> 6.Transporter l Company Name U.S.EPA ID Number <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Tiansporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number - - <br /> DEMENNO/KERDOON <br /> 2000 N.ALAMEDA STREET <br /> COMPTON CA 9'222 CAT 0 9 0 013 3 5 2 <br /> Facility's Phone: (310)537-7100 <br /> ga 9b.U.S.DOT Desorption(including Proper Shipping Name,Hazard Class,ID Number, 10.Containersii.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group III any)) No. . Type Quantity Wt.Nol. <br /> 1NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL P, <br /> 0 SOLUTIONS) y" P 133 <br /> G <br /> w <br /> Z. I HIS WASTE STREAM HAS BEEN QUALIFIED ti' <br /> CD <br /> FOR RECYCLING/TREATMENTS AT THE <br /> i� <br /> 3. LTem LITY IN COMPMN, 4� <br /> CALIFORNIA.t)S ''FACILITY HAS THE NECESSARt — <br /> <. QUALIFIED.0,�k EPA NUMBER IS CAT080018852 <br /> 14.Special Handling Instrµpppns_aOd Apoli6onal Information,. - ,¢-� V" <br /> EMERGENCY CONTACT:CHEMTREC 1.800.4249300 NAERGN 981 171 *PROFILE#9.B-1 383541 ETHYLENE GLYCOL <br /> SOLUTIONS * *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully end 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 applirabentemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I cedify,that the contents of this consignment conform to the terms of the attached EPAAdamwledgment of Consent <br /> I certify that the waste minimization statement identified in 40 Cl 261.27(a)(it 1 am alarge quantity generator)or(b)(if I am a small quanfity generator)is true. <br /> Generatorsl0fiere` P'nted/Typed Name Sign re �� _ .:Month Day Year <br /> / -u1 7c "Ifi t/l7c 'Z_ <br /> -� 16.International Shipments } <br /> � E]Import to U.S. LJ Export from U.S. Pad of enhylexit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporier Acknowledgment of Receipt of Materials <br /> K Trans/pow 1 PrinteOyped Name ` Signature .. F Month Day Year <br /> a <br /> QTransporter 2 Printedrfyped Name Signature Month Day Year <br /> K <br /> 18.Discrepancy <br /> lie.Discrepancy Indication SpaceE - ` <br /> ❑ Quantity El Type I II �d (� ❑Partial Rejection El Full Rejection <br /> A ndest ference Number --- <br /> 186AnimateFacility(or Generator) u { .. f UO U.S.EPAIDNumber <br /> J <br /> Facility's Phone: RWR61ki ll- n"J_Tlh - <br /> J.0 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> 19.Hmrdous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1B <br /> Pdntedrfyped Name Signature r Month Day Year <br /> EPA Form 8700-22(Rev.3-05)VreMous care obsolete. GNATED FACILITY T6 GENERATOR <br />