COMPLIANCE INFO_2025 - Laserfiche WebLink

Home Browse Search

4- Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.PT e 1 of 3.Emer ency Response Phone 4.Manifest Tracking Number WASTE MANIFEST C A L 0 0 _0 0 4 3 0 3 s (808) 424-9300 `` �2U19677 FLE 5.Generator's Name and Mailing Address ne iAdes f dirg Tan mai a, Cess I44Quik Stop Markets, Inc. ;Vroost j 165 Flanders Road Stockton, CA 95210 Westborough, MA 01581 Generator's Phone: (508) 3�0-1400 6.T nsporter 1 Company Name U.S.EPA ID Number LSHIRI CAR000103013 7.Transporter 2 Company Name U.S.EPA ID Number 15,Designated Facili Name and Site Address U.S.EPA ID Number World Oil Recycling C A 4 O e 0 013 3 3 Z 2000 N. Alameda, St. Compton, CA 50222 (310) 537-7100 Facility's Phon • '' ga 9b.U.S. T Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Pac ng Group(if any)) No. Type Quantity Wt.Nol. 0 X 1 UN1203, 00hooline Mixture, 3, PG II a 134 coo Q z 2. W S9 3 e 4. 14.Specig1 anddlAinstructions and Additional Information BES I • 1 S"olkne i 1leter 2r CLo?N171G. Gp CCU: 659237 ; 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, 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 Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 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. Generator llVOjferors PrintedlTyped Name Signature Month Day Year 16.International Shipments F- ❑Import to U.S. ❑Export from U.S. Port ofentry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LU Transporter 1 Printed/Typed Name Signature w - Month Day Year n €'a vl1 - 1 C?r, I e0✓ J` 3c) 1.5 z Transporter 2 Printed/Typed Name _ Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space; ❑ Quantity Type j j❑T e Residue Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number ua- Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z 55 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1 2. 3. 4. T O-1, 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted Item Printed(fyped Name Signature Month Day Year. l EPA Form 8700 (Rev.12-17) Previous editions are obsolete. TRANSPORTER COPY 144/3783828