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h . <br /> Please print or type.(Form designed for use on elite(12-pitcodter.) • •(V Form Approved.OMS No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3 Emergency Response Phone 4.Mushiest Tracking Number <br /> WASTE MANIFEST �j�� 191 7 JJ K <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Generators Phone, <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Dgeignated Facility Name and Site Address U.S.EPA ID Number <br /> Facility's Phone', <br /> 9a, 91p.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. li. .i:n thi LIQUID Oki <br /> 0 <br /> car <br /> 2 T{IIS WASTE STREAM HAS BEEN munEO <br /> FOR RECYCLING/TREATMENT AT THE <br /> 8WENNOIKERMONTACIL—ITY IN COMPTON, <br /> CALIFORNIA.THIS FACILITY HAS THE NECESSM <br /> PERMITS <br /> flUALIFIE4 OUR FPA NUMBER IS CAT0800L= <br /> 14 Special Handling Instructions and Additional Information <br /> R ©I,U.Eu Ahlb E E PROTECTION 24 r1r-njt: /IIIA- �._t(d:`� DRAIPJ OIL sEi1-du <br /> 906"3.sgOq.: . <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 name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects In proper condition for transport according to applicable intemabonal and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified In 40 CFR 262.27(x)IF I am a large quantity generator)or(b)(if I am a&mail quantify generator)is two. <br /> GenemtorslOfierofs Prini Name Signature t / Month Day Year <br /> + n [. �'r7 J . � <br /> i6.International Shipments <br /> � El import to U.S. , El Expert from U.B. Part of antrylexiC <br /> Transporter signature(for exports only): Date leaving U.S.: ' <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printe irryped Name Signature Month Day Year <br /> N / <br /> za Transporter 2 Pdntedrryped Name Signature Month Day Year <br /> rr <br /> r— <br /> * 18.Discrepancy <br /> 18a.Discrepancy Indication Space El El Type <br /> [IResidue ❑PaNal Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility for Generator) U.S.EPA ID Number <br /> J <br /> V <br /> Facility's Phone'. <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> 2 <br /> 19.Hazardous Waste Report Management Method Codes fite„codes for hazardous waste treatment,disposal,and recycling systems) <br /> L 2. 3. 4. <br /> 20.Designated Facility Owner or OIierapar Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a xi� - <br /> Pnnted7ryped Name Signatures Month Day Year <br /> i7 U CJ <br /> EPA Form M00-22(Rev 3-05) Previous editions are obsolete. - DESIGNATED FACILITY TO GENERATOR <br />