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Please print or'ype.(Form designed for use on elite(12-pitch)typewriter,) . <br /> Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator 1D Number 2,Page 1 of 3:-Emergency Response Phone 761405-3430 <br /> ifestTracidng Humber <br /> WASTE MANIFEST ��i,�5.Generators Name and MailingAddress Generatofs Sife Address.(ddifferentthan mailing address) j� <br /> WESTERN TRUCK CENTER <br /> 3333 S. HWY 99 <br /> STOCKTON • CA 95215 3333 S. HIGHWAY 99 <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name OCKTON a <br /> U.S.EPA ID Number <br /> ASBURY ENVIRONMENTAL SERVICES C A D b 2 8 2 7 7 0 3& <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 /> DEMENNO/KERDOON <br /> 2000 N.ALAMEDA STREE <br /> COMPTON CA 90222 <br /> Facility's Phone: t CAT 0 8 0 013 3 5.2 <br /> 92, 9b.U.S,DOT Description QncJuding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> 1. <br /> No. Type Quantify WtNoi. <br /> o NON-RCRA HAZARDOUS WASTE,LIQUID,(DIESEL,ANTIFREEZE) <br /> � J J <br /> w <br /> 2. <br /> D �! G <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT: CHEMTREC 1-800-424-9300.NAERG#9B1;171 *PRO,F�y3�#9B1: 0$0216-2 DIESEL,ANTIFREEZE <br /> MIXTURE* *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT •'�` <br /> 15. GENERA7OR'SIOFFi.-"'2s OR'S CERTIRCATION:I 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 labeled/placarded,and are in all respects in proper condition for transport according to applicable intemalional and national governmental regulations.If export shipment and 1 am tire Primary <br /> Exporter,I certify that the contents of-this consignment conform to the terns of the attached EPAActmewiedgrunt of Consent <br /> I certify that the waste minimization statement Identified in 40 CFR 26Z27(a)(ii 1 am a large quantity generator)or(b)(tf t am a sma11 quantity ecator)is true. <br /> Generatoestoff is Printedrl'yped Name Si Month Day Year <br /> j 16.international Shipments a I rp <br /> ❑Import to U.S. Export from U.S. Part ofentry/e <br /> Transportersignature(for exports only): Dale leaving <br /> 17,Trans porter Acknowledgment of Receipt of Materials .S.: . <br /> 0 T arespo 1 Pdnied(fyped Name <br /> Signature Month Day Year <br /> O <br /> CL <br /> / <br /> Z <br /> Transporter 2 Pnntetl(Typed ame afore �} <br /> Month Day Year <br /> 18.Discrepancy <br /> 18a:Discrepancy Ind'icati0n Space <br /> Quantity ❑Type ❑Residue ❑Partial Rejection Q Full Rejection <br /> Manifest R <br /> J' i8h.Alternate 1 odeference Number <br /> (or Generator) U.S.EPA ID Number <br /> `v <br /> rot Facility's Phone: <br /> w 18c Signature of Alternate Facility(arGenerator) Month pay Year <br /> a <br /> Z <br /> W19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2. 3. <br /> 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials Covered by the manifest except as noted in Item 189 <br /> Printed(fyped Name Signature Month Day Year <br /> SPA Form 8700-2Z(Rev.3-05} us J ditions are obsolete. CD SIGIVATEDFA T`Y STINAT10N STATE(IF REQiJiFiED) <br />