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, e <br /> Please print or type. Form Approved.OMB Nc 2050-0039 <br /> UNIFORM HAZARDOUS 1•Generator 1D Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL 0 0 0 2 0 813 3 1 (800)424-9300 020 3 84351 111 K <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> AUTOZONE#5685 <br /> 8228 WEST LANE <br /> STOCKTON CA 95210 <br /> Generator's Phone: 209 957-1108 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> WORLD OIL RECYCLING <br /> 2000 N.ALAMEDA STREET <br /> COMPTON CA 90222 CAT080013352 <br /> Facility's Phone: uuI <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Co as <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. Ia <br /> 0 '.NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OIL) 223 <br /> DM �(� G <br /> LU <br /> 2' <br /> � U <br /> 3. <br /> i <br /> 4. <br /> 1 <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS NAERG#961:171*PROFILE#951: <br /> AUT1440-051121 USED OIL/MIXED OIL-COMMODITY PACK* *APPROPRIATE PPE EQUIPMENT / 30 <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 P✓maty <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Cons . <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or am mal quantity generator)is true. <br /> Generator's/Offeror -P.rinted/'l'yped:Name a%Signature' — " ' Month Day Year <br /> _ o a <br /> ,J 16.International Shipments <br /> F- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> fX 17.TransporterAcknowledgment of Receipt of MaterialsLU <br /> , <br /> Transporter 1 Printed/Typed Name Sign Month Day Year <br /> 0 <br /> w 1 . ® i Z <br /> Z T ansporter 2 Print dfTyped Name gnature Month Day Year <br /> ~ 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Typej <br /> ❑Residue El Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number, <br /> 3 <br /> to <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month ay Year <br /> 4 <br /> Z <br /> F0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) ' <br /> W 1 2. 3. 4. <br /> G <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a l <br /> PrintedlTyped Name � � � � Signature V Month Day, Year <br /> i 1` !� lul rjJ <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNAT D FACILITY TO EPA's e-MANIFESIT SYSTEM <br /> I <br />