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Please print or type.(Form designed for use on etile(12-pitch)typewriter.) e7511Form Approved.OMB No.2950-0039 <br /> UNIFORM ltA2ARD0US 1.Generator ID Number 2.Page 1 of 3.Emergency Response Ph ne 4.Manifest Trackin Number <br /> WASTE MANIFEST CAC002188290 1 800 955-7761 0 01 7'9 8 81 G B F <br /> 5,Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> BNSF Railroad BNSF Railroad <br /> 740 Carnegie Drive, San Bernardino, CA 92408 tat: 37.95050°N x Lon: 121.25378aW <br /> Generators Phone: 49091.266-351a 801 Dia=nd St. StoeAdon CA 95202 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> PARC Environmental CAT982507154 <br /> 7.Tfansporter 2 Company Name U.S.EPA ID Number <br /> Philip West Industrial Services CAR000177527 <br /> 8.Designated Facility Name and SAa Address U.S.EPA ID Number <br /> Rho Chem Corporation <br /> 425 Isis Avenue, Inglewood, CA 90301 <br /> Facifl sPhone: IBM$70-6233 <br /> 9a. 9b.U.S.DOT Descrlplbn(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any}) No. Type Quantity M.Nol. <br /> c 1' Non-RCRA, Hazardous Waste Solid(Oil&Absorbent) 2 <br /> (ERG#171) 3 DM 800 P <br /> LU <br /> 2. Non-RCRA, Hazardous Waste Solid(Soil and Oil) <br /> (ERG#171) 13 D 9750 Q <br /> 3. <br /> 4, <br /> 14.Special Handling Insbvdlons and Additional Inlormation <br /> 1,Waste Oil and Absorbent-Pro6leill!385800-01(3X55G On). Carden;trltar proper OSHA approved <br /> 2.Waste ON and Soil-Profileg 338887-00(13X55G OR). Personal Protea Equilpmesd(PM <br /> iAlrert Aandt6g rhe r®bartals an els <br /> 4A1RC Som: M52 ' - <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 labeledlplafarded,and are in all respects in proper condition for transport according to applicable inlemational and national governmental regulations.U export shipment and I am the Primary <br /> Exporter,I cartify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a targe quantity generato (b}(i1I am a small quantity enerator)is We. <br /> Generalorsl0fterors Print yped Name Sig rt�kw Month Day Year <br /> f J c9e,1 I)ex- <br /> 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylea <br /> Transporter signature(far exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Tran5porler;olijitedfTyped Name Signature Month. Day Ye .a <br /> y d2 a7 1 <br /> Q Transporter 2 PMtedfTyped Name Signature Month Day Year .£ <br /> 18.Discrepancy <br /> 18e.Discrepancy Indication Spacety ❑T ❑ El I'd Resection <br /> ❑ Quanti Type ❑Residue Partial Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Fadlity(or Generator) U.S.EPA lD Number <br /> tt <br /> LL FadBty's Phone: <br /> W S8c.Signature ofAltamate Facility(or Generator) Month Day Year <br />` a <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU1, - 2. 3. <br /> Facility4, <br /> 20,Designated Facility Owner or Operas r.Certifiratio tpt of hazardous materials covered by the manifest except as noted in[tern 18a <br /> PrintediTyped Name Signa Day Year <br /> � r0/ 2 <br /> EPA Form 8700-22(Rev. -0 Previous editions are obso s. <br /> 10888.1975 DESIG D FACIL TO DESTINATION STATE(IF REQUIRED) <br /> 1 <br />