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sc <br /> Please pfinl or? pe'.(porm designed for use on elile(12-pitch)typewri(er) Farm Approved.OMHNo.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator lD Number d'of 3.Emergency Response Phone 14.Manifest Tracking Number <br /> i (800}429300WASTEMANIFEST 013085423 JJK <br /> 5.Generator's Name and MailingAddresa Generator's Site Address(Ildigerent than mailing address) <br /> MARCH LANE$HELL-MAR654 j <br /> 1206 E MARCH LANE CR <br /> STOCKTON 825 96"797 95210 , <br /> Dimensions Phone: I <br /> 6.Transporter i Company Name U.S.EPA ID Number <br /> ASBURY ENVIRONMENTAL SERVICES C A D 0 2 8 2 7 7 0 3 6 <br /> 7,Transporter 2 Company Name US.EFA Number <br /> 8.Designated Facility Name and She Address U.S.EPAID Number <br /> OEMENNO/ KERGOON <br /> 2000 N.ALAMEDA STREET <br /> COMPTON CA 90222 CA T 0 8 0 01 3 2 5 2 <br /> Facdity's Phone: ($: 01 X3'1-7100 <br /> ga 91b.U.S.DOTOespiplbn(Nclufing Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12:unit 13.Waste Codes <br /> HIM and Pecking Group of any)) No. Type Quantity WWuI. <br /> o PION 41CRA HAZARDOUS WASTE,LIQUID(OILY WATER) D M. � 6 223 <br /> JJ <br /> z 2. <br /> 3. <br /> 4. _ <br /> 14.Special Handling Instructions and Additional Information <br /> rmERGENCYCONTACT:CHEIt REC 1-13OM24-SMNAERG#981:171= PROFILE#981:05022014 OILY <br /> WATER*P0#A1i0185548"APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of Oils consignment are fully and amumely described above by the proper shipping name,and are classified,packaged, <br /> marked and iabeledfplacarded,and are In all respecle in proper condition for transport according to applicable International and national govemmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the lemns of the attached EPAAcknovledgmenl of Consent. <br /> I cer ity that the waste minimization statement idendfied in 40 CFR 262.27(a)Qf I am a large quanfily generator)or(b)(f I am a small quanfity generator)is hue. <br /> GeneratoeslOReroes Pdnled/Typed Name Signature., Manm Day Year <br /> 16.International Shipments <br /> F ❑Impart toU.S. ' ❑E VII from U.S. Pod of enlry/edt <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w17.transporterAckrwwledgment of Receipt of Materials - <br /> Trempaderit'sri�nledRyped Name / Signature Manm Day Year <br /> Izo <br /> Q Trenspoder2 Pdnted/Typed Name _ (�Sign'atere - Month Day Year - <br /> r•-. <br /> r <br /> } 18.Discrepancy - <br /> 18a.Discrepancy Indication Space 1-1Quantity ❑Type ❑Residue ❑ParOal Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> (: <br /> 16b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Fadiys Phone: <br /> W 18Q Signature otAllernate Facility(or Generator) - Month Day Year <br /> zz <br /> m19.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> wLJ{ (1-�%v,�� <br /> / 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PdntedRyped Name n Signature Month Day eer <br /> 14 2 1141. <br /> EPA Form 8700-22(Rev.3-05) Previous editichs are obsolete. DESIGNATED FA0lffY15 GENERATOR STATE (IF REQUIRED) <br />