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Please print or type, (Fonndesigned for use on elite ( 12•pilch) lypawriler.) Form Approved. OMB No, 2050.0039 <br /> UNIFORM HAZARDOUS 1 . Generator ID Number 2. Pagel of 3 Emergency Response Phone 4, MonllsslTracking Number <br /> WASTE MANIFE57 CAT 0 0 0 6 1 8 6 3 7 1 (800 ) 4249300 017 5 9 G 2 9 0 JJ K <br /> 5. Generators Name and MaIFngAcidress Gonorat )rs Silo Address (Irdifferent than mailing address) <br /> TESORO STOCI(TON TERMINAL <br /> 3W3 NAVY DR <br /> STOCKTON CA 952.015 <br /> G <br /> enerators Phone: 714 RM- 1540 <br /> r 1 Company Name U.S. FPA 10 Number <br /> ORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 H 2 7 7 0 3 o <br /> t 2 Comparg• Name U.S- EPA ID Number <br /> d Facility Noma amt Silu Addfoss U.S: EPA 10 Number <br /> / kE. FtOCTON <br /> 00 N AlAMEDA STREET <br /> COMPTON CA 90222 CATQSU413362 <br /> Fac4u rs Phono 310 1537- 7 ' <br /> 9a. 9b, U.S, DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 1D. Containers 11 - Total 12, Unit <br /> HM and Packing Group (f any)) 13. Waste Codes <br /> No. Type Quantity Wt.Nol, <br /> I 1 NOWKPA FIAZARDOU9 WASTE , LIC1011) I U9ED OIL / MIXED (AL)10 221 <br /> DM <br /> W 2 <br /> � I <br /> 3- <br /> 4. <br /> 14. Speciat Handling Instrucilons and Additional Information <br /> EMERGENCY CONTACT CFIEMTREC 1-800.424-9300 WOES TERMINAL CERES CS Or PROLIFILF 0 981 438486 USED OIL / <br /> MIXED Ott * r APPROPRIATE PPE EQUIPMENT j <br /> 15, GENERATOR'S10FFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately dpscdbed above by the proper shipping name, and are Gassified, packaged, <br /> marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary <br /> Exporter, i certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent, <br /> I ceM that the waste minimization statement identified in 40 CFR 262.27(a) (If I am a large quantity generator) or (b) (if I am a small quantity generator) is true. <br /> Genemlors/Offero(s Prinled/Typed Name Sgnature Month Day Year <br /> !f•� i-ter �.-. �.,,.�-. � . : . ( -. �_ <br /> —j 16. International Shipments ~ <br /> r. ❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: <br /> z Transporter slgnaluie (for exports only): Date leaving U.S.: <br /> TV.17, TransporterAcknowledgment of Receipt of Maloriais <br /> .Transporter 1 PdnIWTyped Name i Snalure <br /> G I9 Merrill Day Year <br /> ZZ Transporter 2 Prinled/Typed Name Signature Monty Day Year <br /> j18 , Discrepancy <br /> 18a. Discrepancy Indication Space L1 Quantity El Type EIResidue ❑ Partial Rejection ❑ Full Rejection <br /> - Manifest Reference Number. <br /> 18b. Alternate Faclilly (orGeneralor) U.S. EPA 10 Number <br /> U <br /> LL FacgitysPhone: <br /> Ift S�naluro olAllomats Facility (or Generator) <br /> Alonlh Day Year <br /> Q <br /> a <br /> 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling sys(ems) <br /> W 1 2 3. 4. <br /> G <br /> 20, Designated Facility Omer or Operator, Certification of receipt of hazardous materials covered by the manifest except as noted in Ilem 18a <br /> Pnnled/Typed Name Signature Month Day Year <br /> EPA Form 8700.22 (Rev. 3.05) Previous editions are obsolete, GENERATOR 'S INITIAL COPY <br />