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Form Alu,. oved , OMB No. 2050.0039 <br /> Please piirti or 1ypi3. (Fotnf des!(If1cd for use on elite ; 12•p`s1Cfi) typety€11f f.} 2. Page 1 of 3. Emergency Response Phone a. f t•rnifest Traeking Numbct <br /> f UNIFORM HAZARDOUS Le <br /> 1 . Generator ID Number 0 *� 7 7 9 1 3 5 8 J � <br /> WASTE MANIFEST CAD 0 2 8 2 7 7 0 3 6 1 (800) 424 9300 lJ ! �7 V <br /> 8: Cin r t Na no nst ++.f ritir: At1d€oss Conora'.or's Silo Addfoss (if rimorent than malting addfess) <br /> t1R LN�iIRC"�INIENTALSERVICES <br /> 1300 S . SANTA PE AVE C <br /> COMPTON A 90221 <br /> Generator's Phone: . _ . .. 310 886-3400 U.S. Ef'r1 iD P1urYvr <br /> Gcompa, Nitw CA0028277036 <br /> r = I3Urtf r. rVIRONMENTALSERVICES <br /> U•S: [PAID Number <br /> 7. Tronsprer 2 Company Name <br /> _ U,S: EPA ID Number <br /> 8. Desi m ILO FaAA Kzurs: and SIL Arjdroas <br /> BURY ENVIROi NAENTAL SERVICE - CERES <br /> 1920 MORGAN RD: <br /> CERES CA 95358 CAL 00393680 <br /> Fan"itis Phone: ( 209)541:1825 <br /> ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Contalr>ars ti . Tolel 12. Unit 13, Waste Codes <br /> aril Packing Group of airy)) No, Type Quantity WWoI. <br /> HM I — <br /> 1NON- RCRA HAZARDOUS WASTE; LIQUID ( USED OIL / MIXED OIL) 221 f <br /> 0 001 TTj , G <br /> � 1 i <br /> 1 <br /> I ' r <br /> LU <br /> ' 1, Spa aiH ro'.I 1 in€ct ons and Pddu Dual lnfarrr alicR <br /> EMERGENCY CONTACT : CHEMTREC 1- 800.424-9300 WOES TERMINAL: *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT * <br /> EMERGENCY CONTACT CHEMTREC 800-424-9300 * TRUCK # <br /> 15. GEN ERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of is consignment are fatty and accurately described above by the proper shipping name, and are classipod, pacfiagad; <br /> marked and labelediplacarded, and are in all respoos 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 tho contents 0this ccasignrnant conform to tine terms of the attached EPAAeknovlecigment of consent. anoretat Is true. <br /> I certify that the waste m €�:n zatl.n statement idr'nti ted In X10 CFR ; 62.27(a) 011 am a large quantity generator) or (b) (if I am a email 0050 1,� ii ) <br /> y7.,n f r <br /> Month Day Yom <br /> ndllFName <br /> Cenemfo'Vem =aPv ; <br /> - r1fr. Ir1rZ,na2€cns, Sfi plm!n s ❑ Import to U.S. ElExportlfom U.S. Port of antrylaxiL <br /> F- Date leaving U,S.: <br /> Z� Transporter signature (for exports only): <br /> rx 17 Transporter Acknowledgment of Receipt of MaWals Mfrklh Dray Year <br /> W r,zsa w �3, <br /> it rr t r sGJ;; {�,r.ie ✓ r <br /> rentt 1 t hP a r't t! 1J 3 1 _1 1 1 p €' t A > f ✓ - = — Month Day Year <br /> Transporter 2 Printed/ fyped NameSignature <br /> r- <br /> 18, Discrepancy <br /> { ��--1t ❑ Residue Partll Rejection ❑ Full Rejection <br /> 18a. Discrepancy Indication Space <br /> 1 .1 QuanOty El Type <br /> tSonifast Rn;aten:e yu:n!'e€: <br /> D.3; EPA ID Qiwi bur <br /> I 8b. AJlomato Fa a ty (c. Cirnrator) <br /> V <br /> LL Fadz;CVs Phone: Mon* uq Yea' <br /> W 18c, Signature ofAllernate Facility (or Generator) I <br /> 19 Hazardous Waste Report Management Method Cc-des (I e., codes for hazardous waste treeirnenl, disposal, and recycling systems) 11 MAW <br /> 4 <br /> 1 I <br /> ri <br /> 2V Dr ,i;. , ,;.: I racif ly (honer or Ope4blor t; < .: ,,.rrq j, of recurpt of hazardous materials covered by the manifest r s t ' " .ti r 18a t , j D ,., ^r <br /> WAAAi 1 <br /> era <br /> EPA F.€rn 8700-22 (Rev. 3-05) C'rF. r ,yrs . •i,u <br />