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Please print or type. Form derail for use on a 12-pRoh writer' Form A ad,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS I.G Iffndcr ID Numher - 2.1 1 of 3.Emergency Response Phone 4.Mani Trucking Number <br /> WASTE MANIFEST CAL 0 0 0 2 6 9 3 7 5= 1 (800)424-9300 014 0 512 91 JJ K <br /> S.�psraP CH N gu klatllnp.AOddress Generators Site Address Of difwant than mailing address) <br /> 3927 CLARK DR. <br /> 91OCKTON CA 65,205 <br /> Generator&Phone- 209462-1927 <br /> l 9.Transporter 1 Company Name i EPA ID Numher <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> t 7.Transporter 2 Company Name <br /> U.S.PPA ID Number <br /> 0.Designated Fadi Name and Ste Address U.S.EPA ID Number <br /> WORLD OIL-SAN JOAQUIN, LLC. <br /> 14287 EAST MANNING AVENUE <br /> PARLIER CA 93648 CAL 0 0 010 2 7 51 <br /> Fedi s Phone: (559)498-0240 <br /> ga, 9b.U.S.DDTDesa4pllon(IMudirg Proper Shipping Name,Hanrd Class,ID Number, 10.Contelners t1,Tdd 12,Udt <br /> HM and Padditg Group(Manyl) 13.Waste Codes <br /> No. Type OuaMity WtJVoI, <br /> o. NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/ MIXED OIL) <br /> 221 <br /> a4 <br /> 001 T T <br /> I w z I-- <br /> 3. <br /> 4. <br /> 14.3pealal Hani instructions an Addlllwallnfamatlon <br /> EMEI <br /> 3GEii CONTACT:CHEMTREC 1-800-424-9300*APPROPRIATE PERSONAL PR TEE EQUIPME ERGENCY <br /> CONTACT HEMTREC 800 424 9300 Ac,Ile <br /> 15. GENERATOR'f".111 <br /> FEROR'S CFRTIFICATIO . Iherehydaclera tlral econtenk otthk coMgnmentaretulty nde 4'y a by the propershppltg ne ,ab are deeelsetl,packaged, <br /> marked end lehplecarded,and aro In eYr speolp In propercand ntor transportaccordlnp kapplkebk lnle tlo and netlon vemme Irogdelbna.Rex elJpmerdeM tem the Primary <br /> Exporter,IcaNtihe conknh Wlhle con Unme iconkrmk terms of thea ached EPAAdmowledgment C ant <br /> Ice l Ilhea mlNmketlon shleme Identltl In 40 262.27(e)(Ifl ekrge quentlty generelor)ar(bl ameamell snare atNe. <br /> Genera of ror 1 ypatl Name gneture o N Day Year <br /> Iiiitz <br /> .t 6,Interna melSNP u <br /> z ❑I portio U.S. ❑Expartfram U,S, Part Menlryle <br /> Trensparteralgnahue(fo exports only): Dak keMrg U. <br /> w 17.Trewodei-AdmowledgmenlofRecelptofMekdala <br /> Transporter i PintMTypad Name <br /> O Signer M* Day Year <br /> cp � <br /> Transporter 2 PentsollypiR Meme Signature Month IDay <br /> YgiK <br /> F <br /> .p 10.Dlacreparry <br /> 18a.Dlscrepanoylndlcalkn Space Duantl <br /> �❑ b ❑TYPe ❑Residue ❑Partial ReJectlon ❑Full ReJutlon <br /> ManOasl Ralerence Number. <br /> iOb.Altumale Factllty(or Generator) U.S.FPAIO Number <br /> J <br /> U' <br /> LL Facitltye Phone; <br /> w Ise.Signature c Allamate Pinsky lar Generator) Mmtlr Day Year <br /> i N 19.Hazardous Waste Report Management Method Codes 0.0.,codes kr hazardous weals freemanl,disposal,and recycling systems) <br /> 2.- 3. <br /> 4. <br /> 20.Designated FaMlly Owner cx Operator.Certlfica0cn of receipt of hezmdcus materials covered by 91e manifest except as Med In Item 162 <br /> PMted ems fiYgnakre 21Month Day ear <br /> EPA Fomn 8700-72(Rev.3-05) Previous edPoons are obsolete. raNATED FACYLITV TO DE8XI ON STATE(IF REQUIRED) <br />