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Please print or type,(Form designed for use an elite(12-pitch)typewriter.) Form Approved.OMB Na,205HO39 <br /> UNIFORM I AiARDOUS 1 Generator ID Number 2,Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Humber <br /> WASTE MANIFt ST CAD 0 2 8 2 7 7 0 3 6 1 ($DO)424-9300 018530399 JJ K <br /> 5.Ganeralni s Nanta and allln Address Geveiatoi:s Site Address(If different than mailing address] <br /> WORLD'QIL NV�RONMENTALSERVICES <br /> 1300 S.SANTA FE AVE <br /> COMPTON CA 00221 <br /> Generators Phone: 310 886"3400 <br /> Us.EPAID Number <br /> B;Trarfspotter.1 Company Name CAD 0 2 8 2 7 7 0 3 6 <br /> WOI3LI3 41L ENVIRC3NMENTAL SERVICES <br /> U.S.EPA ID Number <br /> 7 Truilspa(er.2CompanyName <br /> 8 Oas gltaEe€f FaCP)ry Nam9.end Site Address U.S.EPAID Number <br /> ASgl1RYENVIRONMENTALSERVICE CERES <br /> 1920:MORGAN RD. <br /> CERA:.CA 95358 CAL000393680 <br /> Fasii ty 8 Phone 209 541-1825 <br /> in mama,Hazard Class,ID Number, 10.Containers 11.Total f2.Unit <br /> 8a 9b U S OOT Description(including Proper Shipping 13,Waste Codes <br /> HM! <br /> gad Pa No. Type quantity VdtNal. <br /> 1 NON RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCAL 133 <br /> SDLO.NS) D 01 T T G <br /> Ufl <br /> i tX' t <br /> % <br /> r <br /> 4 ' <br /> i <br /> �14xS IPI Ilandlftsg lusin olohn andAdrfiftal Information <br /> M1ERGI=NCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERESL. AP ORATE PERSONAL PROTECTIVE <br /> ��UIPME'NT*EMERGENCY CONTACT CHEMTREC 800 424 9300 *TRUCK# <br /> zl5i NERATW'BtOFFEROR'.S CERTIFICATION: I hereby declare that the contents of pais cahslgpme0t are fully and sccUm,lely desult(ed above by the propel shipping name,and are classiCed,packaged. <br /> labdiedlplacarded,and are in all respects In proper condition for transport according to appiiiablu Iniamafional and national governmental regulations,If export shipment and 1 am the Pdrnwy <br /> x tq )oeitify Eftat the contents of this cansignmentoonform to the terms of the attached EPAAeknowledgmant of Consent, <br /> rr <br /> IIiLk Itis waste minimization statement Identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ill am a small gVantity generator)Is he. <br /> � `rot` gai+s P'niedlT me sig ro fdortSh Day Year <br /> /0 <br /> a <br /> I <br /> Ii.8 IrItr I Sltiprnenls <br /> rr ❑[m l� Port of en loxg: <br /> . port to U.s. Ex rom U ky <br /> TragspH slg,:attrie(for exports only): Data letkvtrlg U.S,: <br /> I 1 gragiovdadgment of Receipt of Materials <br /> r1,�tfn _ .ypedNar� Sign Month Day Year <br /> 2Prfttti3 .ypod onto ;n, tifonpr Day Yo <br /> 22 <br /> r � <br /> , D)t?erepaney llsd:catien Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection <br /> El Full Re)ecgan <br /> Y m' ' <br /> t a ' <br /> Manifest Reference Number. <br /> 1 <br /> 4ab Alternate 1 aGitity;(ar.iatloratol) U.S,EPA)D Number <br /> 1 adil,I(IS Phone: <br /> W nc.SlgnalufeofAllern acility(or Qeenerator) Month' pay Year <br /> a , <br /> 19.Hazardous Waste Report Management Method Codes(i.a.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> a <br /> 20,Designated Facility Owner of Opamlor,Certification of wcelpt of hazardous materials covered by the manifest except as ncted in Item 19a <br /> Printettf yped Name Signalufe Month Day Year <br /> - - I 0 03 <br /> Form 8700.22(Rev.3.05) Previous editions aro obsolete. DESIGNATED FACIL.ITYTO DESTINATION STATE(IF REQUIREL)) <br />