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Form Approved.OMB No.2050-0039 <br /> y rise Phone 4.Manliest Tracking Number <br /> Please print or type. 72Page 1 of 3.Emergent Respo 20 7 69 JJK <br /> ,,Generator ID Number p (8001 q24-931M <br /> UNIFORM HAZARDOUS / A L O O O 4 6 51 1 <br /> WASTE MANIFEST b Generator's Site Address(if different than mailing address) <br /> 5 Generator's Name and Mallin Address <br /> IRES TRAY <br /> a 11TH 5T CA 9537` <br /> TRACY <br /> 916 743-M6 U.S.EPA ID Number <br /> Generator's Phone: CAD 0 2 8 2 1 7 0 y9 r' <br /> 6.Trans �gyMRONMENTAI-SERVICES U.S.EPAIDNumber <br /> 7.Transsppoderer 22CCompany Name <br /> r�, dtgAd U.S.EPA ID Number <br /> 8.Desj9Rgt Lbilb aKtLYtitlN�ess <br /> 2000 N.AIAMEDA STREET CA 90222 r A T 0 8 0 0'1 3 3 5 2 <br /> COMPTON <br /> Facility's Phone: (31.0)517.7100 <br /> 10.Containers 11.Total 12.Unit 13 Waste Codes <br /> ya 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, No Type Quantity Wt.Nol. <br /> HM and Packing Group(if any)) <br /> 0 DM <br /> 135 <br /> Z <br /> LU Tv <br /> c7 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT!CHEMTF;. t-804-+1249300 WOES TERMINAL:CERES Ci NAERWi 8411:171.982 .III PROFILE p <br /> 9B1 tY22$71 61G700 OLD WASER,962 BIG700-VV 22 OILY WATER* "APPROPRIATE PPE EQUIPMENT ^� j <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 intemational 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 ofdth aamltaa Iar�eEuantickn enlera9orent orobC flsenmall,t. uanti generator)is true. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(' 9 quantity generator) ()( q ty 9 ) Month Day Yea <br /> Signature f -s <br /> GpneratorintedlTyped Name ,.^ f <br /> 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> zDate leaving U.S.: <br /> Transporter signature(for exports only): <br /> a 17.Transporter Acknowledgment of Receipt of Materials Mont Day (er <br /> Transporter 1 Printed/Typed Name Signature, <br /> O a't- <br /> 0 Signature Month Day Ye <br /> Z Transporter 2 Printed/Typed Name <br /> r <br /> 16.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Residue ❑Partial Rejection ❑Full Rejection <br /> ❑ Quantity ❑Type <br /> Manifest Reference Number. <br /> U.S.EPAID Number <br /> 18b.Alternate Facility(or Generator) <br /> _J <br /> V <br /> ra+ Facility's Phone: <br /> W 18c.Signature olAltemate Facility for <br /> Generator) Month Day <br /> Q <br /> 2 <br /> CD <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 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 /> Printed/Typed Name Signature Month D <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S Ir �` <br />