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Please print or type. Form des ned for use on elite(12•01ch)typewriter.) Form Approved.Olde No.20511.0039 <br /> UNIF0RMHA*00US 1.GeneratalDNumber 2.559e;i olf 3.Emergency Response Phone .ManifestTrackin Number <br /> WASTE )IFI sT: C A L 0 .0 0 0 1 1 0 3 2 800 .424-9300 0.1.0.15'9 12 0 . ,1�K <br /> S.Generators Name and A <br /> 1aft Address. Generators Site Address(d dEerenl Than rnaft address) <br /> JjF.FY LUBE#698 <br /> 1430 N.MAIN S7 113RN NMN$T <br /> MANTEDA CA 95336 it%TECA <br /> Generator's Plane: 709 <br /> 6.Transporter 1 Company Name I r <br /> ASBURYENNRONNENTALSERVIGES C A D 0 Z: 0 2'10", 7 0 3 '6 <br /> 7.Transporter 2 Company Name U.S.EPA ID M - <br /> TH <br /> 6.Des"IedFaMyNameand&oAddrass - U.S.EPA 1011 , <br /> OK MON VIR hl1 <br /> 7300OHEVRON WAY D��'ART�E <br /> BXQN CA 96620 <br /> Fadri?s Phone: (7071693.01008 C A T 0 $ 0 0 1 2 6 0 <br /> ga. 9b.U.S.DOT DesaOp on(ndur"Proper$Epping Name.Hazard Class,ID Nwnher, 10.Containers 11.Total 12,.Urol 13.1Yaste Codes <br /> M and Paddrg Group(d any)) No. T}pe ftflRy YAMI. <br /> 1. <br /> 4 223 - <br /> NON•RGRA HAZARDOUS WASTE,LIQUID(OILY WATER) 0 01 ` TT v b G <br /> z 2. <br /> Uj3 <br /> 4. <br /> 14.Special HaMErg tnstru000ns andAddfaral tnfonna6m <br /> NAERG#:901 : M'PROFILE#91311:MOM 10"EfVfER4.MY GONTACT:GHEMMEG i4NXM4-9300%ADDITIONAL EPA <br /> CODE$:.991 :,NONE`APPROPRIATE PERSONAL PROTE071VE EQUIPMENT <br /> 16. GENERATOR'S!OFFERORSCERTIFICATION:Ihereby deftethat hecontents ofihlscgr*nmepfaiofulyand accaratefydesmwatavabyrhapropershtppngname.ardare dassM.Packaged, <br /> marked and laheledlptacarded,and are in as respects In proper corMn for transport aow*d q to appwue intsmational and national gowrnnental requ)atans.If export Wprnenl and 1 am the Primary <br /> Exporter,I co*wt the contents of llds oons�wrtt conform to the terms of tiro alladW EPAAdmasledgment of CotmrnL <br /> I certify WIN waste.mtrdmhal;n statement Identified in d6 CFR 262.27(a)(d 1 am a large Quantity generates)or(b)(dl am a"quantity genwata)fs he. <br /> Gane+alorsfOffera s Pr>fl3edtlyped <br /> U66 = fSgrg.yes /�° )ronth )Day Year <br /> -1 16.International Is <br /> 0 Smport to U.S. F-W from U.S, Par of entrylexil <br /> Transporter signature(la exports only): Date(eavuug U.S.: <br /> 17.Transpodeikk wA{edgntenl of Rece:pl of hfateriais <br /> rY 7ransporter i Pdnted7TypedName Stgnadxe MoNhDay_ Ye1 1.pr <br /> >U C� aYv"G' ''. <br /> Transporter 2 Printedfliyped Name S1gnavo 7M0h 7-Day year:. <br /> F- - <br /> 16.Discrepancy <br /> 189.MerVancyind'aa6wspace ❑puart<dy ❑Typo OResrdue ❑Pa1tialRe;eCtiorr ❑FullReiezbon <br /> ldardtesl Reference Number. <br /> 161J.Aftsmalo Facility(or Generator) U.S.EPAID Number <br /> V <br /> iy Faaws Plane: <br /> w Ift Slgnalno ofAltemato Fadly,(orGenerala) hor+th [MY Year <br /> 19 Hazardou Waste Re hfanagemen(Method Codes p.,codes for hazardous waste treatment,disposal,and feWyg systems) <br /> 2. 3 d. <br /> 20.Oesignated Faa q Rner or opet Of Cefffn%n of receipt of hazardous matedala covered by the marftl except as Win Item 1 <br /> Pdnted1l)"d Marne S grtature MoA Day, Year <br /> EPAform8700.22(Rev,3.05) Previousedrtfonsareobsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF_REQ IRED) <br />