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Please print or type. Form Approved.OMB No.2050-00 <br /> UNIFORM HAZARDOUS 1•Generator Il)Number 2.Page h of 3.Emergency Response Phone 4.Manifest Tracking Number �( <br /> WASTE MANIFEST J J K <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> "OBER TS TRUCK REPAIR ' <br /> HARRISON ST <br /> CIS CP 95203 641 SOUTH HARPLSON STREET <br /> Generators Phone: ,3 ST KAON <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 'LD OIL.ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7,Transpoder 2 Company Name U.S.EPA ID Number <br /> 8.Design aclility Name and Site Address _. -- — U.S.EPA ID Number <br /> OIL RECYCLIN <br /> N. ALAMEDA STREET <br /> ON CA 9021711Facility's Phana: a7-71 <br /> ga 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 Wt.Nol. <br /> 1. <br /> WASTE FLAMMABLE LIQW0 <br /> ' LINE!DIESELI. 3. PGII <br /> W 2 Y <br /> t7 7P..JS WASTI-STREAM HA5 S£FiV <br /> RECYCLII]G1Ti E�TIU: Ir i AT T ,- <br /> nQIL RECYCLING FAt:I: Y Ii.4•- l: <br /> 3. <br /> CALIFORNIA,THlS FAClL1' ", r -S'i RAJ Pry <br /> PE;MITS TO R.CEIVE Y(7UQ vJASTL <br /> QUALIFIED.OUR EPA NUMBER 13 CAT0800 3352 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 2-90Q42-C 3 WOES TE[RMAINAL: NA RG#981:128 *PROFILE#981 4842k, <br /> �s=:'.INE/r►I>=S.L * k APPR`PR:',TE °P= FOWOMEINT <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 labeledlplacarded,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,I 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)(if I am a small quantity generator)is true. <br /> Generator'slOfterors Printed/Typed Name Signature Month Day Yea <br /> 16.Intemational Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment ofReceipt ofMaterials <br /> LU L <br /> Transporter i PrintedlTyped Name Signature Month Day Yea <br /> O <br /> R. <br /> Z Transpotler 2 Prinied/Typed Name Signature Month Day Yea <br /> 9 <br /> 18.Discrepancy <br /> 16a.Discrepancy Indication Space ❑ Quantity ❑T <br /> ype ❑Residue ❑Partial Rejection E]Full Rejection <br /> Manifest Reference Number: <br /> F 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> rQi Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Ye r <br /> a <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU I 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedfTyped Name Signature Da Ye <br /> 14 7y <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOO <br />