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Please print or Type.(Form designed for on elite(12- itch)typewriter.) Ss.. - x ,.- Farm Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS I'.Generator ID Numbers 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST 4 r`i 4' a' c3 CY fb f3 (WO)4.24.93CO ��n� 53391 <br /> JJ K <br /> 5.Generalors Name and Mailing Address q Site Address(if dlilWant than mailing address) <br /> WEST LANE.CHEVRON Lj <br /> 8454 WIff t LANt RuT2 4,®.xs u `�'STOCKTON � 1C <br /> Generalor's Phone: 9'25 9R&3797 <br /> 6.Transporter 1 Company Name. .4 LU10 U.S.EPA ID Number <br /> P's 8VRY rel'/IR1011 M C- Tr'L 5E Fiv(cE.S C A D 0:2 2 ?;' 7 1 � <br /> f <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> ENVIRONMENTAL.HEAL�H s <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> I<>I~1r0114 %KERE:t:1ON u 5 <br /> 2000 N.ALPiMEI;A STREff <br /> COMPTON <br /> A'1'0300 13 a. <br /> Fadlity's Phone: <br /> ga, 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total Q.Unit <br /> HM Quantity and Packing Group(if any)) Nn Type ty WLNcI13.Waste Codes a <br /> . K <br /> �, 1 t,(ti!IJ,33.`•,�(�.a it FGr?ti59MASI-E 011RID,N.U.S. <br /> Ful f <br /> /, ' <br /> LU l <br /> Z 2. @ <br /> W <br /> 0 - <br /> n <br /> 3. 3It <br /> 4. <br /> 14.Spedal Handfing Instructions and Additional Wormallon <br /> EMEIRGENCY CON1TACT:CHENITREC 800-$24-9,?CQ NAERG O 961:171 " PROFILE T"r SB.1.:07`1?}6 <br /> �16-11 Gr",SOLINEPNA-TE9 <br /> APPFOPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> 15. GENERATORVOFFEROR'S 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 labeled/placarded,and are In all respects In proper condition for transport according to applicable international and national governmental regutallons.If export shipment and I am the Primary <br /> Exporter,I cer6ly that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Corient <br /> I certify that the waste mintmizalton statement i aritiflad in 40 CFR 262.27(a)(if I am a large quanity gener�tdr)or(b)(If a mall quanlipenerator)is true. t: <br /> Geri`erat°s(Offerorg, rhl yped Nae Sign a ,�/1 Month Day Year <br /> 17 1Jb <br /> .1 16.Ihlernationa(Shipments t <br /> ) ❑Import m U.S. ❑Export from U.S. f Port of enlrylaxl n <br /> Transporter sipI ature(for exports on y): / Dale leaving U. .: <br /> 17.Transporter Acknowledgment of Receipt of Maledals <br /> Transpoder 1 Pdnledfiyped Name Signature Month Day Year <br /> ./ r - -� Gin=�'°'�,,,� 0 I 1 1 <br /> U) <br /> Transporter 2 Printed(Typed Name Sfgnalure Month Day Year <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Partial Rejection ❑Full ReJecflon <br /> _ g <br /> Manifest Reference Number- <br /> 18b. <br /> umber18b.Alternate Facility(er-Generater) U.S.EPA ID Number <br /> U <br /> �. Facility's Phone: r <br /> w 180.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.H�zardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> W 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 1t)a 1 r <br /> C <br /> PrinledfTyped Name Slynature ) Month Day Year <br /> VCi <br /> EPA Form 8700-22(Rev.3-05) Previous editions aro obsolete. DESIGNATED FA61LITY TO GEN€RAZOR STATE (IF REQUIRED) 1 <br /> F <br />