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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number <br /> 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST A p 13 Q 9 .1 4 €; � � G 3Y 3oG-$fi�4 014082521 F L E <br /> S.Generato(s Name and Meiling Address Generator's Site Address of drfferent Than mailing address) <br /> OV".F=NS BROCK A.Y GLASS CONTAINER <br /> 14700 VEST SCHULTE ROAD <br /> TRAr,.'! CA 95376 <br /> Generator's Phone: 2 <br /> 6.Traikspllrter t Company Name U.S.EPA ID Number <br /> ENVIRONMENT,",L&CHEMICAL CONSULTING, 'INC y A R 0 0 0 2 4 1 4 4 ^a <br /> I.Transporler 2 Company Name. U.S.EIA 10 Narn ier <br /> 8.Designated Facifity Name and Slle Addrgs-s U S.EPA ID Number <br /> California Oil Transfer <br /> 5300 Claus Rd <br /> Riverbank CA 95367 <br /> FadlltysAhorwr tti -f�-_ A L 0 0 0 1 0 0 8 1 5 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No Type Quantity WtNol. <br /> )JON RCRA HAZARDOUS WASTE L QUID(,:SIL:''.^,A.TER1 <br /> Af <br /> T, <br /> w <br /> Z 2 <br /> UJ <br /> t7 <br /> 3. <br /> 4. <br /> 14_SpKWdandlinglnstrucli tsandAdditionalInkrmalion 1)ERG#150 9B OILY_VATER PRC#11,7918-9!-COT ERG#150Oc 27Y0ERG#1513 <br /> ERG#15Q dILLEi�C,P,O BC)rC 316:3,CREST►LINE.CA 92'325 <br /> &k7-f- <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION: 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 international and national governmental regulations If export shipment and I am the Primary <br /> Exporter,1 certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262 27(a)(if I am a large quantity generator)or(b)(i I am a small quantity generator)is true- <br /> Generator's/Offerors PrintedlTyped Name Sigriature MCI* Day Veer <br /> —►N�= J tst-c /YJ/`Y 20 <br /> 16.International Shipmenta <br /> F ❑Import to U S ❑Export from U.S Port of entry/exit: <br /> z Transporter signature(for exports only) Date rea+nng U S <br /> W 17 Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 PiintediTyped NamfSignature Month Day Year <br /> O <br /> ILAell", 44445- �'J, 20 <br /> Transporter 2 Nntedffyped Name Signature Month Day Year <br /> 18 Discrepancy <br /> 18a Discrepancy Indication Space <br /> Quantity Type Residue Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> F 16b.Alternate Fad%for Generator] U.S.EPA ID Number <br /> J <br /> U <br /> ra Facility's Phone: <br /> M 16c.Signature efAllemata Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> H19 Hazardous Waste Report Management Method Codes(i.e,codes for hazardous waste treatment,disposal,and recycling systems) <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 nded in Item 18a <br /> Ponted,typed Name Signalure Month Day Year <br /> EPA Form 8700-22(Rev 12-17) Previous editions are obsolete DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />