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irnt or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Eme ency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C A L 0 0 0 40 7 '0 3 0 1 610-562-6181 024549125 JJ K <br /> 5.GUi11i2O M�Mailing Address OPyI 0 Ines c�riatte �d ess(if different than mailing address) <br /> 44131L0aCover Street 1469 E Hammer LN. <br /> Long Beach CA 90808 Stockton CA 95210 <br /> Generator's Phone: 3 1 0 1 - 3 2 3 - 3 9 02 <br /> 6.Transporter 1 Compan Name U.S.EPA ID Number <br /> Bayview IMustrial Services, Inc C A R 0 0 0 3 4 7 4 9 2 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> Al glean Hazardous Waste Removal Inc C A D 9 8 2 4 9 2 3 9 9 <br /> 8.DbMi&AVtkV&dASite Address U.S.EPA ID Number <br /> 2000 N Alameda Street <br /> Compton CA 90222 <br /> Facility's Phone: 310 537-7100 C A T 0 8 0 0 1 3352 <br /> ` <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> 1.UN 1993,MSTE Flammable liquids,n.o.s. DO01 D01$ 3d 3 <br /> o 3.PGIII 9(Gasoline) ®®f DM 3 G <br /> z z. <br /> w <br /> 0 <br /> 3. <br /> 4. <br /> 14.Spec I Handling Instructions and Additional Information <br /> 1%as station test water. ERG#128 Invoice disposal to Bayview Industrial Job#22806. BIS#22806. <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: 1 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 intemationaland national govemmental 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 statemeni identified in 40 CFR 262.27(a)(if I am a large quantity,generator)or(b) 'I am a small quantity generator)is true. <br /> General eroes Pdnted/Typed Name Signature Month Day Year <br /> 16.Intem tional Shipments <br /> 1- ❑Import to U.S. ❑Export from U.S. Port of an <br /> ? Transporter signature(for exports only): _ Date leaving U.S.: <br /> W17.Transporter Acknowledgment of Receipt of Materials - <br /> I-- Transporter 1 Printed/Typed Name �t Signature Month Day Year <br /> n Nick Cleveland 0 11 9 812 3 <br /> Z Transporter 2 Printe yped Name. Signature Month Day Year <br /> P A l (, - <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantit <br /> y ❑Type El Residue ❑Partial Rejection ❑Full Rejection <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 /> Q <br /> a <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLI� 1 ��� 12. 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 ped Name Signature Month Da Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e•NIANIFEST SYSTEM <br />