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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C A`1­0. 0,.:0 -4 0 7 0 3 0 1„ 510-$82-81$I 024550260 JJ K <br /> 5: neratars d:Mailing Address om o Ins 4 Generators SiteAddress(if different than mailing address) <br /> �nited `p United#3447, . <br /> 413Q.Cover Street- 1469 E-Hanvyier LN. <br /> Long Beach. CA 90805 Stockton CA 95210.:. <br /> Generator's Phone: 3 1-0 1 - 3-'2 31 3'9-9 2" <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Bayview Industrial.Services,.l no C A WO 0 0 3 4 7 4 9 2 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> Ai Clean Hazardous Waste.Removal-Ino ICAD 9 9 2 4 9 2 3 9 9 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Demenno- erdoon <br /> 2000:NAlameda.Street . <br /> ,Compton CA;90222 . <br /> Faciiity s Piiorie '310'"'.137=7100 CAT 0 8 0 0 1 3 3 5 2 <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM I and Packing Group(if any)) No. Type Quantity WLNol. <br /> ..UN:1gg.3,, 4STE Flaremtableliquids.n.o s D001 0018' 343' <br /> o X ''3 PGIII(Gasoline <br /> z 2. <br /> w <br /> t7 <br /> 3. <br /> 4. <br /> 14.S ec'al Handlin Instructions and Additional Information <br /> '�)hasata�on:testwater. ERG#128,. Invoice disposal to Bayview Industrial Job#22808. CGRS#231.70.8._ <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 of the attached EPA Acknowledgment 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)(ifI am a small quantity generator)is true. <br /> Generator')CANQ)-t <br /> Offerors Printedffype ame Signature Month Day Year <br /> ` J `9, (2 2 <br /> 16.Intemational Shipments <br /> F ❑Import to U.S. ❑Export from U.S. ort of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Transporter 1 Printed/fyped Name Signature Month Day Year <br /> .0 - Nick Cleveland... , . . . 0 7 1.1.. 2 g <br /> Transporter 2 Printed/Typed Name Signature Month Day Year <br /> M I C .,'-z ®`7 I Z.3 <br /> 18.Discrepancy Irl <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type j ❑Full Re' <br /> ❑Residue Partial Rejection Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> LL FacilitysPhone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> rQesignat�ed <br /> aste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 2. 3. 4. <br /> acility Owner o Aerator:Certification of receipt of hazardous materials covered by the manife cept ernm ^ ^, ,� xww,� R) <br /> Sig tur2-17) PreviiouusJ�e{dditions are obsolee. DESI A D ILITY TO EPA's e-MANIFEST SYSTEM <br />