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Pieria print or typw i <br /> pones Phone mlfeat II oNrl Approved.OMB No.2050 0039" <br /> NIFORM HAZARD003 1 rata'ID Number 2,Page 1 of 3.Emare rby e Res <br /> WASTE MANIFEST A L 0 0 0 4 0 812 2 <br /> 5.Generators Name and ARI Address 91968 JJK <br /> Ganereton's SNe Address{fi different than malirg addr } <br /> 22 L40UN MARINI!RE9pRT-MCDOMW RD <br /> 129Bs W.McaaNAL�ROAp <br /> 3TO.Kf CJN CA 95206 <br /> Generator's Phone: 204"2M <br /> 8.TranapaRIf f Company Name <br /> WORLD OIL ENWRONMENTM.SERI U.S.EPA ID mmber <br /> 7.Transporter 2 Company Nerve <br /> CA0026277038 <br /> U.S.EPAID Number <br /> B.Desigrreted Fadlihr Name and S1teAddresa <br /> WORLD OIL RECYCLING U.S.EPA iA Number <br /> 2000N,A EDA STREET <br /> COM" CII 90222 <br /> FadRI es Phan: fft,0 7.1100CAT 0 8 O 013352 <br /> ga. 9b.U.S.DOT Description(including Proper Shlpptmg Name,Hazard Glass,ID Number <br /> HM and Pafto Group Cdani 10.Contalners 11.Total 12.Unit <br /> g� %wRCIR1 WASTE.LIQUID(OILY WATER) No. Type quantity WLN01. 13,Waste Codes <br /> = 2 r DM 3 Q <br /> W <br /> 3. <br /> 4. <br /> t4.5pedal.Hencling tnahucfiorna Additional frdormalion <br /> EMEW"WWMT:CNEMTREC 1410042"M WOES TERMINAL•CEDES()q Nin"89�, 171*pROME <br /> 4M73 OILY WATER + *AppROpRIATE PPE EQUIPMENT 8981: <br /> � <br /> ii—IrF <br /> 15. t3ENERATOR'�fOFFEROR'9 CER7IFlCATIoN: I hereby declare drat the of thio consigrxment are fuly and accUratd described above 8b 1 <br /> maMced end tabeledlptarandad, are ap respects in proper cardldan farbu$Port according to applicable inigmatianatamd rmtonal Prefer ramal and are classified,padreged, <br /> Exporter,I ceft tot the contents of this oonslgMTM santorm to the terms of the attached EPAAcknwledgmi of Canaent. amu tell ff export shipment and I am the Primary <br /> 'cel that the weals minimlzadon"eft nt Ider lfied In 40 CFR 282.27(.)(d I am a large qual generator}or(b)(dl am a small <br /> Aeneretar'slQfNror's PrlydadlTyped Nems quantity generator}la hue. <br /> Month Day Year <br /> 16.Intermadonel Shipmentsi ,h fi r <br /> ❑Impart to U.S. ❑�rtfrom U.S. Port ofentrylexlt; <br /> —Z7Yensportersignature(forexportsady): <br /> cz 17.TransporterAdmowisdgmentofRscelptOfMafadals m9 U.S.: <br /> TrenPoder 1 MdlryPed Kama V . Signature <br /> Month Day Year <br /> ? ra-sporW2 yped Narne `✓ J r 1 cr-t •• '� <br /> Signature MOFM Da Y,ar <br /> 18.Discrepancy <br /> lea.Dlscrepamcy Indication Space <br /> 13.quantify ❑Type <br /> ❑Resldue ❑Partial ReJsctien ❑Ful Rejection <br /> 18b.Atf!emataFactiity(ort3errerator} MardfestRefererrcaNumber. <br /> ca <br /> U.S.EPA IA Number <br /> FacilVs Albite: <br /> 18c.Signalu a of Fadlty(or <br /> Month Day Year <br /> W 19.Hazardous Waste Report Managemeth <br /> ent Mal Codas(I.e..rendes for hazardous waste treatrnsnf die <br /> 1. 2 poral,and moydhV syaterns) <br /> 3' 4. <br /> 20.Oeaprnelied Fadl[fy Owner or operator Cerdficaticn Of receipt of hazardous M Mata covered by the mardfest <br /> yped ams except n noted in 16sm 18a <br /> Y Year <br /> EPA Form 8700 22(Rev.12-17) Previous 1:111111 ions are obsolete. <br /> GENERATOR'S INITIAL COPY <br />