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b. <br />riot or' e (Form d nalik t2 -Pilch) typewrtter.) V <br />Form Approved. OMB No. 2050-0039 <br />Please <br />p ,Yp <br />UNIFORM HAIARO U <br />"': <br />1: Genera r ID Number <br />".0"A0026277038 <br />.� <br />2. Page 1 of <br />1 <br />3. EmeS pes o s hone <br />4 )4��-e$ [:'U <br />4. Manifest Tracking Number <br />�J� �J JJK <br />WASTE MANIFEST <br />S. Gene! e a AL SERVICES Generator's Site Address(ifdiparent than nailing address) <br />1300 S.SSAWA FE AVECOMPT <br />CJI. 9022]. .. <br />$10 8983400 - t <br />Genembes Prune: :. <br />6. Transpe eZOiaAMONMENTAL SERVICES ..- ." •..' Us. EP6Igr�i' r(afr2 8 2 7 7 0 3 S <br />7. Lansporter 2 Company Name -Mi U.S. EPA ID Number <br />B. padgr�atedfatdvName'a� U.S. EPA IO Number <br />ENVIRONMt=NTAL.i-iEALiN <br />2000 N.ALAMEDASTRE�f <br />,. <br />COMPTON CA -90222 DEPARTMENT CAT080013352 <br />FaciBtysPhone: (310,1537-7100 <br />ga <br />9e. US. DOT Desc iptiun (IMwtrg Proper Shipping Name, Hazard Gass, 10 Number, <br />10. Containers <br />11. Total <br />12 Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Padu'ng GMUP In enYI) <br />Quantity <br />Wt Nd. <br />1. NC,'N-PCFiA HALAHWI.95 WAZ I E, Lis; (OILY W Y. <br />135 <br />i <br />9 <br />1 <br />G <br />I <br />I <br />z <br />2. <br />w <br />� <br />` <br />1 <br />3 <br />4. <br />14. Special Nagging Irmtmcllons and Additional Information " <br />EFAERGENCY CONTACT: CHEMTREC 1-800-424-9300 NAERG #961:171 * PROFILE 009B1: OILY WATER * * APPROPRIATE <br />PERSONAL PROTECTIVE EQUIPMENT PARS WASHER OILY WATER POA 0.110180550 41 1,/ <br />�io�%)/ I,/l `3L) <br />15. GENERATOWSIOFFEROR'S CERTIFICATION: I hereby, declare that the contents of Tis consignment ere hdlg and accurately described above by the proper shipping name, and are caissl8ed, packaged, <br />marked and labeledfplacarded, and are In ell respects In proper coglBon for transport according to applicable mlematlonal and national govemmental regulators. If export shipment and I am the>rimary <br />E porter, I certiry that the contents of this wnsignmeml conform to the terms of the atlached EPAAaknovdedgment of Consent. <br />I oergly that the waste minimizatlon state= identifled In 40 CFR 262.27(x) (If I son a large quantiy generator) or (b) Of I am a small quantltygg0 is 9. <br />Goner (tenor's Priv am Signature / Month Day Year <br />16. International Shipments <br />1:1 Import toU.S. port ❑Export bum U.S. Portofentrylexi: _ <br />Transporter signature (far exports only): DaR leavbg U.S.: <br />w <br />17. TranuomuAdawWedgment of Racaipt of Materials - -. <br />T 'n Vyped Na /� Signehxrx` Month Day Year <br />Transputer 2 PrintedrTyped Name Signature Month OaY Year <br />18.Oisaepancy <br />18a. Disocgency Indication Space ❑quantity El Type L IReeldae L 1 Pamal Rejection ❑Full Refection <br />Manifest Reference Number. <br />181h.A8emats Factily (or Generator) U.S. EPA lO Number <br />U <br />sa <br />Facility's Phone: <br />w <br />1Be. Signature ofAtiemale Fedltiy(or Generator) <br />Monty Day Year <br />r <br />19. Hazardous Waste Report Manegement Method Codes (I.e., codedf hazardous waste treatment, disposal, antl recycling systems) <br />G <br />, 1-r' <br />2 3. 4. <br />20. Designated Fadllty Owner a Operator: Certifi®tlon of receipt of hazardous manda4s cDa.W "a men8est except as Med In Varn Ias <br />PrintaCypedi Name Signature Month Day Year <br />1 <br />VIVU <br />EPA Forn 8700-22 (Rev. ) Prev icons are obsolete. - DESIGNATED P ITY T GENERATOR STATE (I R ED) <br />