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UNFOd[i HAZARDOUS <br />WASTE MANIFEST <br />'1. Generatol lD Numbercl&0000a3rt1 2. Page 1 of <br />I <br />3. Emeeency Response Phone <br />(r00t 421*e300 02a181468 FLE <br />gutk Stop llrrkctsr IDc. <br />165 Flandcrc Road <br />o.kfr.t.f;o.f,ough, lll 01 581 <br />clloooltt9ltBEIATTRE <br />Inc. ll3B?iIT trEB"TrffiH:lnayr dl 953?6 <br />5.Name and Mailing <br />7. Transporter 2 Company Name U.S. EPA lD Number <br />I <br />8. Designated Facility Name and Site Address <br />Iorld Oll Reoycllng <br />2000 N. atereta stl <br />rsffffihgn, cr 90222 <br />U.S. EPA lD Numberct!0to01tt3t <br />t3101 53?-?x00 <br />10. Containers9a. <br />HM <br />9b. U.S. DOT Dessiption (including Prcper Shipping Nann, Hazad Class, lD Number, <br />and Packing Goup (if any))No.Tvpe <br />11. Total <br />Quantity <br />12. Unit <br />Wt.luol. <br />13, Waste Codes <br />134 <br />(.nr TW\r13G <br />6x' wlzot, Grro}lnr rLrtun, 3, Fo rr <br />2. <br />3.,] <br />4. <br />14. Special Handling lnstruclions and Additional lnformalion. <br />llBlc 12O€uollnr I rat.r <br />BESI3376a85 <br />OEIf,8loP OEN; 5592!? <br />I Y '-'"." <br />GIT I;L TPPnOFnIIIAtlntilr& lrstrcfivrclr,lf,IIg <br />Exporter, I certiry that the conbnb of tris consignnEnt confom to the terms of the attadled EPA Acknowledgment of Consent. <br />I certify that the waste minimization stabment identified in 40 CFR262.27(a) (il I an a large quantity generator) or (b) (if| am a small quantity generator) is true. <br />Jt- <br />= <br />lmport to U.S.Export from U.S. <br />Date U.S.: <br />17. TmnsporterAcknowledgment of Receipt of Materials <br />tTo'.rk -Tfr,,o $ I ,f',^*^L fi,^,o,* <br />Monh Day Yearl5l6le' <br />Transporter 1 Printedflyped Name Signature <br />18. Discrepancy <br />Day Year <br />Partial Reiection Full Rejection <br />18b. Aftemate Facility (or EPA lD Number <br />Residue tr <br />Phone: <br />lsa.Discrepancylndicationspace E euantity Erro. <br />.l9. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous wasb treatment, disposal, and recycling systems) <br />H U C. <br />3,4. <br />20. Designated Facility Owner or Operator: Certilication of receipt of hazardous materials mvered by ttle manifest except as nryd in ltem 18a <br />EJof <br />I <br />OMB No.2050-0039 <br />Form 12-17) Previous obsolete.TRANSPORTER COPY138/3879214