COMPLIANCE INFO_2021 - Laserfiche WebLink

Home Browse Search

l Please print or type. Form Approved,OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number. 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 3 3 0 4 2 3 1 (800)424-9300 020380611 JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Q AND M. DBA TRACY CHEVROLET-QAN001 3400 AUTO PLAZA WAY TRACT' CA 95304 Generator's Phone: 209 835-4500 6.Transporter 1 Company Name U.S.EPA ID Number WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number WORLD OIL RECYCLING 2000 N.ALAMEDA STREET COMPTON CA 90222 CAT 80013352 Facility's Phone: q q 7- ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt./Vol. 13.Waste Codes 1'RQ, UN1993, WASTE FLAMMABLE LIQUID, N.O.S.,(GASOLINE, ' D001 D018 343 DIESEL), 3, PG II D M5 G Z 2. w c9 3. 4. 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS NAERG#9131: 128 *PROFILE#9131 : 421485 GASOLINE, DIESEL * *APPROPRIATE PPE EQUIPMENT#,�,O J), 5 15. GENERATOR'S/OFFEROR'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, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and n tal regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmen ent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity or or(b)(if I am a small quantity ator)is true. Generator's/Offero ed Name Signature Month Day Year /0 16.International Shipments F. ❑Import to U.S. ❑Exportfrom U. . Port of entrylexit: ? Transporter signature(for exports only): Date leaving U.S.: of W 17.Transporter Acknowledgment of Receipt of Materials � Transporter 1 Printedrryped Name Signature Month Day Year z Transporter 2 Printedrryped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity El Type F-1 Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z C— 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 31 2. 3. T- 20. Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedrryped Namer� `� Signature Month Day Year Eiln t w � �0e� IIo EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNA ED FACILITY TO EPA's e-MANIFEST SYST M