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0 0 <br /> OTSC. 0.0590. 2155 <br /> Please print or type.(Form designed forum on elite(12-pitch)typewriter.) Foam Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2Page l of 3.Emergency Response Phone 14.Manifest TracMng Number <br /> WASTE MANIFEST I CAL000327206- col+ + 1 909.721-2038 001870828 JJ K <br /> S.Generators Name and Magi Address Generators Site Address(if different man mulling address) <br /> CONOCO PHILLII SIMARRY BODDEN <br /> 600 N DAIRY ASHFORD,TA1024A CONOCONOCO 2708671,8608 THORTON RD HOUSTON,TX 77079 STOCKTON,CA 95209 <br /> Generators Phone: 209-478-8959 <br /> 6.Transporter 1 Company Name UI FPA ID NumAw <br /> ENVIRONMENTAL LOGISTICS,INC CAR000172478 <br /> T.Transporter 2 Company Name U.8 EPAID Number <br /> e"--TIf'Irtx-*9 TL[IT5691 VICES. INC. U.S.EPA ID Number <br /> 180 W.MONTE AVE CAD982444481 <br /> RIALTO,CA 92316 <br /> Fadl' sPhone: 909.421-2012 <br /> go. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard pass,ID Number, 10.Containers 11.Trial 12.Unci 13Waste Cade <br /> HM and Parking Gmup if any)) Na. Type Quantity W1Nd. <br /> 1 I DIM n•,\ P 352 <br /> o LY' <br /> w 2 G 34 <br /> 3. <br /> 4. <br /> 14.Special Handir Instructionsand Additional Information <br /> 98.1)ABSORBENT W/FILTERS#06010509 InC69-- WEAR APPROPRIATE PPE INV#49143 <br /> 9B.2)WATERW/GAS#03102110 ,JbCSs"' <br /> 15. OENERATORR OFFEROITS CERTIFICATION: I hereby declare that the mntenfs of this consignment are fully and accurately described above by the proper shipping name,and ere deserted,packaged, <br /> marked and labeladlplacardad,and are In all respect;In proper codon fortrampon according to applicable international and national govemmemal reguators.If export shipment end I am the Primary <br /> Exporter,I tardy that the ocrdenbs of this cansgnment conform to the terms of the attached EPAAcknowladgment of Consent <br /> I cortiy that the mete minimization statement idemfied In 40 CFR 261 Cd I am a large quantity generator)or(b)(HI am a small quantity generator)is We. <br /> GeneretofslORerors Printed/Typed me Signahue Month 'y Year <br /> T 16.Intemadonal Shipments (�` c9J D/l <br /> ❑Import b U.S. ❑FapoR from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> K 17.TmnsPoRsrAclwxdedgment of Receipt of Materials <br /> Transporter 1 RinMdRyped Nanta Signature Month Day YYeeary- <br /> a 3 13t Iv) <br /> m <br /> Transporter PmartgarlypW Name Signature Monty Day Year <br /> } 78.Discrepa-5 _ <br /> 18a.Discrepancy Indication Space ❑ Ouanay ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Mankst Reference Number <br /> 18b.Alternate Faaldy(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Fadliys Phone' <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> y19.Hazardous Waste Report Management Method Codes Cie..codes for hazardous waste treatment disposal,and recycling systems) <br /> W1, 3. 4. <br /> 2. <br /> DD 1 <br /> 20.Designated FapTdy,Owner Operator Cemficadon of receipt of hazardous materials covered by the manifest except as noted In mem f So <br /> -nmleNTyped Name Signature Month _ Ilay Year <br /> S e <br /> EPA Form 8700-22(Rev.3-051 Previous editions are obsolete. DESIG,w&ED FACILITY TO IMSTINATION STATE(IF REQUIRED) <br /> 10317.0135 <br />