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VA <br /> Please print ortype (Form designed for use on elite (12•pitch) typewriter ) Form Approved. OMB No: 2050-0039 <br /> 1'M . . Generator;ID Number 1.2: Page i 'of 3 Emergency Response Phone 4. Manifest Tracking Number <br /> UW S7EMAN ESOUS CAI. C) 00301238 1 800) -'j2rY �J300 � .�� � '�3 �9All <br /> 5 i� JJK <br /> 5iGenerators Name and Mailing Address Generator's Site Address (if different thah, mailing address) <br /> CEWEKE MOTORS - GEW003 1 <br /> 102 HANSEN DRIVE r <br /> L ODI CA 95240 <br /> Generators Phone: 20136&0861 <br /> 6. Transporter 1 Company Name ! , U.& EPA ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICCT CAD 0 2 8 2 7 7 0 3 6 . <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 8, Designated Facility Name and Site Address U.S. EPA ID Number <br /> WORLD OIL RECYCLING <br /> 2000 til . ALAMEDA STREET <br /> COMPTON 4 CA 90222 CAT 0 8 0 !) 13 3 5 2 <br /> Facility's Phone: 1310 %5, 7_ ' it <br /> •ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers iL Total 12, Unit 13, Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantity Wl.Noi. <br /> tUN1263 , G'VASTC �4q�T�lk�� >p j(� 5 , . : ) r 001 343 <br /> , r <br /> GM G <br /> z 2.:. " r, bI HLAM HAS BEEN OUALIFIED I <br /> LU FOR REC`rCLIP•! GiTr? EA T P;IENI- AT 1 FIE <br /> 0 DeNIENINIO/KEROOON DBA WORLD OIL F 11 <br /> RECYCLING FACILITY I ('nitriPTMI <br /> 3 1 T slo l`V /AULI I Y FIALS THE NECFS 1R `i r�Et (MiTS TO <br /> RECEIVE YOUR WASTE STREAM AS OUALIFED, <br /> OUR EPA NUMBER IS CAT080013352 s' . <br /> . . . <br /> 14, Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT : CHEMTREC :1.=800-424-9300 WOES TERMINAL CERES CS NAERG# 9B1 : 12.8 . * PROFILE * 9B1 <br /> CEW003-1.2249.9 `4VAPTEtPAIINT W ; APPROPRIATE PPE EQUIPMENT L FP F <br /> 15. GENERATOR'SIOFFEROR',S CERTIFICATION: 1 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 iabeledlpiacarded, 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 certify 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 quant�yye erator) is true. <br /> Generato slOfferors Printed(iyped Name Signatu ' Month Day Year <br /> F y i t C X14 <br /> A. <br /> 1.� ALL <br /> i <br /> 16. International Shipments <br /> ❑ Import to U.S. ❑ Export from U.S. Pori of entry/exit: <br /> Z 'Transporter signature (for exports only): Date leaving U.S.: <br /> iY 17. Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Transporter 1 Printed/Typed Name • Signature Month Day Year <br /> <.�. t ass, . .. - � ! 01 <br /> QTransporter 2 PrintedlTyped Name Signature Month Day Year <br /> H <br /> 18. Discrepancy <br /> 18a; Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection " El Full Rejection <br /> Manifest Reference Number: <br /> 18b. Alternate Facility (or Generator) U.S.' EPA ID Number <br /> V <br /> uQ Faciiitys Phone: r <br /> UJ 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> a Y <br /> Z <br /> 19. F azardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and. recycling systems) <br /> j�� � 3. 4• <br /> 111 " € 2. <br /> 20. Designated Facility Owner or Operator: CeHificatlon of receipt of hazardous materials co4ered by the manifest except as noted in Ite 8a <br /> . P nled(Typed Name t Signature / / / aY <br /> G� Mon D Year <br /> 44d *d P4 <br /> t/! 4 4 <br /> EPA`Form 8700w22 (Rev, 3.05) Pre4ious editions are ob olete. �� DESIGNATED FACILITY TO GENERATOR <br /> L LL <br /> � / <br />