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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL 0 0 0 3 5 8 9 7 3 1 (800)424-9300 026707834 JJ K <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> TRACY SHELL <br /> 1450 N BENSON AVE,STE A <br /> UPLAND CA 91786 3725 N TRACY BLVD <br /> Generators Phone: 951 300-8264 TRACY CA 95304 <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 I Number <br /> PACIFIC RESOURCE RECOVERY <br /> 3150 E. PICO BLVD. <br /> LOSANGELES CA 90023 CAD008252405 <br /> Facility's Phone: (800)499-7145 <br /> 9a, &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 W1.1vol. <br /> "UN1325, WASTE FLAMMABLE SOLID, ORGANIC, D001 D018 352 <br /> N.O.S.,(PUMPS/HOSES/DEBRIS).4.1, PGII <br /> D M P <br /> z 2. <br /> w <br /> C7 <br /> 3. <br /> 4. <br /> 14.Special Handling instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES CS NAERG#9131 : 133 *PROFILE#9B1: <br /> 22131245 PUMPS/HOSES/DEBRIS *P500-00135616 *APPROPRIATE PPE EQUIPMENT l `t S5- <br /> 15. GENERATOR'SlOFFEROR'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 Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable intemationaland 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 EPAAcknowledgment 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 /> Generators! es PdrtedlT ed Name Signal Month Day Year <br /> �YV <br /> ,j 16.International Shioments <br /> ii ❑Import to U.S. ❑Export from U.S. Port of entrylexil: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> IX 17 Transporter Acknowledgment of Receipt of Materials <br /> w <br /> � <br /> Trans30sl.-e- <br /> U) 1 Printedfryped Nam Signature Month Day Year <br /> a <br /> Transporter 2 Printed/Typed Name Signa re Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Type I j❑Residue Partial Rejection Full Re ection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> U <br /> LL Facility's Phone: <br /> W 18c Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems( <br /> 0 1. � � 2. r <br /> 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 /> PrintedlTyp ame ® 60 �� Signature Month Da Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA'S e-MANIFEST SYSTEM <br />