COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

'K B Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3,Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAD 0 2 8 2 7 7 0 3 6 1 (8001)4.4 Q3o0 017 6 9 6 0 2 2 JJ K 5.Generators Name and Mailin Address Generators Site Address(if different than mailing address) WORLD OIL ENVIRONMENTAL SERVICES 1300 S.SANTA FE AVE COMPTON CA 90221 Generators Phone: 310 886.3400 6.Transporter 1 Company Name U.S.EPA ID Number WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number ASBURY ENVIRONMENTAL SERVICE-CERES 1920 MORGAN RD. CERES CA 95358 CAL000393680 Facility's Phone: 209)541-1825 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(f any)) No. Type Quanlliq Wt Vol. 1-NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL 133 SOLUTIONS) as 001 TT � ` G z 2. to f.7 3. 4. 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL: UNION CHIT,Y�CSS *APPRORIATE PERSONAL PROTECTIVE EQUIPMENT*EMERGENCY CONTACT CHEMTREC 800 424 9300 *TRUCK 15. GENERATOR'SfOFFEROR'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, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemation and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that tiro consents of this consignment conform to the terms of the attached EPAAckrowledgment of C ent I certify that the waste minimization statement Identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b) f am a small quantity generator)is true. Ge eratoesfOff roes Prinledfi Name ign to Month Day Year N —r 116.International Shipments F— ❑Import to U.S. ❑Export from U.S. Port o entry/exit _ Transporter signature(for exports only): Date aving U.S.: w 17.TransporterAckncWedgmentofReceipt ofMaterials Tnth Day Year OT7 a QTransporter 2 PdnledrF*d Name Signature Month Day Year 1-- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V uu< Facility's Phone: W 18c$ignatura of AI1RmatR Fadlity(or Generator) Month Day Year a a 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 2. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year �VA 1Z Z I f3 EPA Form 6700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)