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<br /> -Please print or type.(Form designed for use on eine(12-pitch)lypeyrriler) .,; Form Approved.GM8 No.2050-0035 =
<br /> UNIFOkM HAZP Ftf)OUS t Generator ID Number 2,Page i of 3 Emergency Response Phone 4,Manifest Tracking Number g
<br /> WASTE MANIFEST 1,;s'4 D R`s G t" -"e k f 'y (: D) 9-31,,5 f y �!J
<br /> 5,Generators Name and Mailing Address Generators Sila Address{if dlftereni lhdn mailing address}
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<br /> GeneratorsPhane: 1+E - '=�.5.-:�hr ;>
<br /> 6.Transporter 1 Company Nama U,S.EPA ID Nombe€
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<br /> 7.Transporter 2Company Name U.S.EPA ID Number
<br /> P.Designated Fpcility Name and Site Address U.S:EPA ID Number
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<br /> Facli3y'sPhone: '•7']_Cf%}
<br /> ga 9h,U.S.DOT Description(Including Proper Shippkig Name,Hazard Class,ID Number, 10.Cordell ars 11,Total f2.Unit 1a.Waste Godes j
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<br /> and Packing Group(if any)) No. Type Quantify Wtivol,
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<br /> 2.
<br /> :fI-1IS WASTE STR FAM HFl5 Bt FN QUALIFIED
<br /> FOR RF ! 1 — I
<br /> a, DetvlENNO/KCHDOON DCIA WORLD OIL
<br /> RFCYCLHIG rACl1 ITY IN COMPTOhI,CAJFORNIA,
<br /> TI-11;S FACILITY HAS T11C.NKESSA;'Y PFRIAJTS TO !
<br /> 4. OUR LVA r-)t rI,'Eil —
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<br /> 14.Special Naitdling Inslruatiohs.and Addilional Infomiattgn C" ''• "ru'r..Ki. y
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<br /> 15. GENERATOR`SIOFFEROR'S CERTIFICATION:I herebydeclare Thal the contents of this consignment are fully and accurately described above by the propershfpplig name,and are classified,packaged, j
<br /> marked and labotedfplacirdod,and are In all respects in proper condition far transport according to applicable international and national govemmenlal regulations.If export shipment and I am the primary
<br /> Exparte,t certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmenl of Consent. j
<br /> I certify that the wasla minimization statement Iden€fged in 40 CFR 262.27(a)(If.1 am a large quantity generalok)or�b)Of an)4-'stnall quantity geneialoi)Is true.
<br /> Genera tor'sf_Offeror's Prm1edfTyped Name Month Day_ Year-
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<br /> s 16,International Shipments
<br /> !— ❑Import to U.S. ❑Export from U.S. Poitof entry/oAT ;
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<br /> Transporter signature(for oxporfsanly): Date leavingU.S,: j.
<br /> LW 17.TransporlerAcknowledgment ofReceipt ofMaterials
<br /> Transporter 1 PrintedfTyped Name Signature J Month Day Year
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<br /> ZTransporter 2PrinledyrypedName Signature. Month Day Year
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<br /> 18.Discrepancy
<br /> 18a.biserepancy Indication Space ❑ Quanlity ❑Tye �❑Residue ❑prtfaE Rejection ❑Fug Rej
<br /> eclion
<br /> Manifest Reference Number:
<br /> 18b.Altemahi Facility(or Ganeralar) U.S.EPA ID Number 3
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<br /> Facility's Phone: i
<br /> 18c.Signature ofAllemale Facility(ur Generator) Month Day Year
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<br /> f9.Hazardous Waste Report Management Melhod Codes(i.e.,codes for hazardous waste keatmeni,disposal,and recycling systems)
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<br /> 20.Designated Fad Cvmer or 0 orator:Ceriifiea6ori o1 fecalpt of hazardous materials covered b the manifest except as ncted in Item 18a
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<br /> PrintodffypodName- ! - }} SNrialure Month - .D _j
<br /> a/{y, Year'
<br /> EPA Form 8700-22(Rev,3-05) Previous editions are obsolete.
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