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18 <br /> f. <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Foran Approved.OMB No.205MO39 <br /> UNIFORM NAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manliest Tracking Number <br /> WASTE MANIFEST C A L 0 0 0 3 0 9 6 6 9 1 (800) 4249300 003172694 JJ K <br /> 5,Generators Name and Malin Address Generators Site Address if different than mailing address) <br /> DELTA MARIN?SERVICES INC <br /> 1302 W FRENONT ST 401 N SAN JOSE ST <br /> STOCKTON CA 95200 STOCKTON CA 96203 <br /> Generators Phone: 209 463-0384 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ASBURYENVIRONIENTALSERVICES C A D 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> DENENNO/KEROOON <br /> 2000 NORTH ALANEDA STREET <br /> CONPTON CA 9= CAT 0 8 0 0 1 3 3 5 2 <br /> Facilitys Phone' (310)537-7100 <br /> ga 9b.U.S.DOT Descriptor,(including Proper Shipping Name.Hazard Gass,0 Number, 10,Containers 11.Total 12 Unit <br /> No. Type Quantity WLNd <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> s 223 <br /> 1- NON-RCRA HAZARDOUS WASTE, LIQUID (OILY WATER) 001 T T '0 G <br /> w <br /> w 2. <br /> c0 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> NAERG# 961 : 171 'PROFlLE#9Bi : ' AUTOWTIVE CLARIFlER PROGRAM 'PO# A110092640 <br /> APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> SG/N873767 <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 new,and are dassfied,packaged, <br /> marked and labelednplacarded,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 <br /> Exporter,I cer81y Nat the contents of,this consignment conform to the terms of the attached EPAAcknoMedgment of Consent. <br /> I partly 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 general a no, <br /> Generatorv08erors PnntedRyped Name Sin ManN Day Year <br /> :ZJA - C� D3 IZ v <br /> J 16.Intern tlonal Shipments <br /> p- 11 Import to U.S. ❑Expod from U.S. Port of entry/exit <br /> Transporter signature(for exports only)'. Date leaving U.S.'. <br /> W17.Transporter Ackrrowledgment of Receipt of Matenals <br /> Transporter 1 Panted ed Name SignaNre Monty Fay Year <br /> 2CLJAN �>p AJIL-A o. 1-11 pig <br /> QTransporter 2 PnntedfTyped Name SignaNre Month Day Year <br /> K <br /> r <br /> 18.Discrepancy <br /> i 18a.Discrepancy Indication Space <br /> Quantity LI Type Met Residue Partial Rxejection F II Rel on <br /> Reconciled quantity- 5UAt_on3�g <br /> 18b.Alternate Facility(or Generator) LLS.EPA ID Number <br /> J <br /> U <br /> W <br /> Facility's Phone: <br /> w 18c.Signature of Ntemate Facility(of Generator) Month Day Year <br /> r <br /> Q <br /> 2 <br /> N <br /> 19.Hazardous Wasteeport Management Method Cedes(i.e..codes fix hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2. 3. a <br /> 20.Desgnated Facility Diviner or 0 mtoc Certification of receipt of hazardous materials covered by the maniti as n <br /> Printerif yped Name \ Month Day Year <br /> 2fl J 1 L q:- oy I <br /> h [e <br /> EPA Foran 8700-22(Rev.305) Previous editions are ota. DESI TEDF ESTIMATION STATE(IF REQUIRED) <br /> 10299.1871 <br />