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Please pnrll or type.(Form designed for use on etite(12-Yilcil)SypewiAar.) Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emerpancy Resgense Phony A.Mamfest Tram:king Number <br /> WASTE MANIFEST CAD 9 81 9 6 7 6 8 0 1 (8CO)424.93CO p 4 6 g 2 3 1 JJ K <br /> 5.GeneraJpra�jaM9 Maifir66ddr?NC Generator's Site Address(if different than mailing address) <br /> 31333 AUTO COATER CIRCLE <br /> STOCKTON CA 95212 <br /> Generator's Phone: 209 477-3668 <br /> 6 TranspUS.EPA ID Number <br /> APNV <br /> . CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Trarupoder 2 Company Name U.S.FPA ID Number <br /> 8,DesigDteUnci VD n I<ERDOdm s U.S.EPA ID Number <br /> 2000 N.ALAMEDA STREET <br /> COMPTON CA 90222 CAT 0 8 0 013 3 5 2 <br /> Facllity's Phone: (310)537-7100 <br /> ga. 9b.U:S.DOT Descdplion'(nduding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.-Unit <br /> HM and Packing Group(d any)) No. Type Quantity WUVDI. 13.Waste Codes <br /> 1• UN1993;WASTE FLAMMABLE WASTE LIQUID, N..O.S.,(DIESEL, <br /> _ 1 D001 D018 343 <br /> o GASOLINE),3,PG II D M G <br /> 11.1 <br /> t9 <br /> I <br /> 3. <br /> 4. { <br /> 14.Special Handling Instructions anclAddiliDnal Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-4249300 *PROFILE#9B1:051817-04 DIESEL,GASOLINE * *APPROPRIATE <br /> PERSONAL PROTECTIVE EQUIPMENT �-2"� <br /> 15. GENERATOR'S)OFFEROIZ`S CERTIFICATION:I hereby.declare that the contents of this consignment are fully and ecaualely described above by the proper shipping name;and are classified,packaged, <br /> marked and labeled/placarded,and are In all respects in,proper condition for transport according to applicable international and nallonal•govemmpnlal regulations.If export shipment and I am the Primary <br /> Exporter,I certify[hal the contents of this cbnsignmenl conform to the lerms of the attached EPAAcknowledgment of Consent. <br /> 1 certify that the waste minimization slalem(jntldertified In 40 CFR 262.27(x)pf I am a largo quantity ganorator)or(b)(if I am a&mall quantity genaralor)Is true, <br /> 7kV5,%erVS ftladlTypad Name S(flna m Month Day Your <br /> _1 16.tntem40ooal Shlpmehls <br /> r— ❑Import ou.S. ❑Export from U.S. Port of entry/exit . <br /> z Transporlor signature(for exports only): Dale leaving U.S: <br /> w 17.TransponerAcknowjedgmentof.Receipt of Materials <br /> TiansporIv i Print Name ] r Sk rotwe Month D4y Year, <br /> QTransporter 2 Printed ped Name Signatur Month Day Year <br /> tY <br /> F-- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quanlity ❑Type Residuej j <br /> ❑Partial Rejection El Re eclion <br /> Manifest Roferwnco Number. <br /> 18b.Alternate Facility(or Genera(or) U.S.EPA ID Number <br /> J <br /> U <br /> FacilWs Phone: <br /> W 18c.Signature of Alternate Faciltty(or Generator) Month Day Year <br /> 4 <br /> Z <br /> u19.Hazardous Waste Report Management Method Codes(i.e.,codes for liazardous waste treatment,disposal,and recycling systems) <br /> LLI <br /> 0 1, 2, 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Be <br /> PrinledrTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILIT`!TO DESTINATION STATE (IF REQUIRED) <br />