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Please print or type.(Form designed for use on elite(12-pili,,) Ypewdter.) • Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page l of 3.Emergency Response Phone 4.Manifest TrackingNumber <br /> WASTE MANIFEST ckL990806362 1 562 921-.5581 1 010403689 JJK <br /> 5.Generator's Name and Mailing Address Generators Site Address(H different than mailing address) <br /> THRIF-TY OIL CC'FYPhNY <br /> 13116 IIAPFRIAL HIGHWAY THRIfi-rr OIL CO #171 <br /> SANTA FE SPRINGS, CA 90670 1250 N . WILSON WAY <br /> Generators Phoce: 562 933-3531 Attr.-GREG BRIGGS STOCTMR . CA 95205 <br /> 6.Transporter i Company Name U.S.EPA ID Number <br /> ADAMS SERVICES, INC_ CAM00189431 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Ski Address U.S.EPA ID Number <br /> DEM $ O/KERDOOK <br /> 2000 N- AT.AMFDA STREE.'T (AT080013352 <br /> COWTON_. CA 90222 <br /> Faciliy/s Phone: 310 537-7100 <br /> ga, 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> and Peaking Group(if 13.Waste Codes <br /> HM n9 p( y)) No. Type Quantity WLNoI. <br /> O NOH-RCRA HMARDOUS WASTE LIQUID - <br /> 1— (WATER WITH SPACE HYDROCARB S? '- <br /> w <br /> z <br /> w <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Information <br /> AVOID EYE CONTACT 6 WEAR RUBBER GLOVES ERG 128 <br /> CONTRACTOR: TAFOYA s ASSOCIATES, INC WATER WIT." KYDREICA?BODS <br /> 15. GENERATOR'SIOFFEROR'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 Iabeledlplararded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and 1 am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I cedfy that the waste minimization statement mendfied in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(til am a small quantity generator)is hue. <br /> GeneratoeslORemes Pdntedfryped Name Signature Monro Day Year <br /> 16.International Shipments <br /> F ❑Import to U.S. ❑apon from U.S. Port ofentryledh <br /> = Transporter signature(for exports only): Date leaving U.S.: <br /> IX w 17.TranspoderAcknowledgment of Receipt of Materials <br /> K Transporter 1 Printedrryped Name Signature Month Day Year <br /> O <br /> a <br /> a4 Transporter 2 PrintedlTyped Name Signature Month Day Year <br /> H <br /> } 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity El Type ❑Residue ❑Partial Rejection ElFull Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> h19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Ul1. 2. 3. 4. <br /> 20.Designated Fadlity Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. 005BTNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />