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Pleasa paint or typ".(Form designed'for use on elite(12-pitch)typa:vriler.) Form Approved.CLMB N19,2050.0035 <br /> UNIFORM HAZARDOUSGenarator ID Plan?her 2.^C c 1 of 3, inprclr:ncy Ros'pn,e Phone 4,Manifv5t Tracidag Num(beerQ <br /> WASTE MANIFEST CAL 0 0 0 3 3 t3 4 2 ' ! ( t� j _-' J'U'[3 017 O 9 U C3 7 4 JJ <br /> K . <br /> 5.Ganaratat's P.,,ma o"nd Maling Address Genaraloes S le Address(if different than mailing address) <br /> `ITZAC`f CHEVROLET-Q&tri INN p <br /> 3=140 AUTO PLAZA V11, f <br /> T KAGY CA 9b3clZI <br /> CeaturalaTs Phone: <br /> 201)S-35-4500 <br /> 6.Ttansporer I Corepany Nama U.S.EPA!G plumber <br /> kNORLD OIL ENVIROi+Ni ENTAL SEWCES CAO 0 2 8 2 7 0 3 6 <br /> 7,Transporter 2 Company Name U.S.EPA ID Nurnt a,, <br /> k(1-'RLD VICIE REC'C VLRY SYSTEI 1 INC. <br /> CAR4)OU175422 <br /> 8,De.:gnated FaOily Name and SIOr O5s U.S,EPA$0 Numhar <br /> l UMA YES LLG <br /> 21U30E13iHST <br /> YU11rlt3 R? 85365 AZ.R0005:I.5924 <br /> Facllil(S Phone: (92813441-9823 <br /> 9a. 9b.U.S.GOT Descrip!:an(iodu g P€Oper ShIpp`,ng Name,Hazard Class:ID Number, 10.contalnars 11.TOW 12.Unit 13,rNaste Codes <br /> F ld and Paakintg Croup(if any)) Na. Type Quantity 4?,'€.No!. <br /> '1401'i-RORA 1-4hZARDOUS 10,11%25'i r:SOLID 01L'i' PAP;'--'R;=1l.ERS) 3 <br /> a D N11 P <br /> M 2. <br /> u� <br /> I Spocial Hand rig lnsWsticns and Adauna$tnfatmalian <br /> EiMERSENGY CONTACT:CHEMTREC 1.8010-42q-9300 WOES TER,jl]NAL[ CERES CS *PROFILE#SB1:162G23NR8QAN001 <br /> OILY SOLID, PAPER FILTERS " APPROPRIATE PERSOf AL PROTECTIVE EQUIPMENT <br /> 15, GENERATQR'SfOFFEROR'S CERTIFICA'nO,4; I hereby declare that the cements of this censfgnmant are fully and accurately dsscrifd above by U30 proper shipping nerve,and are doss ted,paoKagad, <br /> tnarl<ed grid labeledipiacardei,and are hi ua respects in proper con itlon for Irarlsport according to appbcabla intentalinnaf and national govemmeotal regulations.It export shipmerdand f am tho Primary <br /> t:xpOW,I Wily that Vire e,nlents of this con5igtt€nnni conform to the€en€m of bre a3auhad EPAAc nivd6dxnlcnt of Caasi:rit, <br /> I ee Uy that the wade fn;ArT'1Lakn slatemetn ldtm fled in 40 CFR 262,27(a)#if I am a large quantity generator)or(b)(irl am .a€qua ty ganeratar)is true, <br /> (fit? tOa'sCff'crOi'° Sign curb Month Day Year <br /> --1 16.Iain al'sanal Shipments t�l tf��ff <br /> F ❑ImpOrt to U.3, I-1 aw from U.S. art of entryfexit: <br /> 2 Transporter slgna€urn(for exports onlyJ; Date leaving U.S.: j <br /> 17.Transporter Acknowledgment 0 Receipt of Materials <br /> Tmnsporj t rinfcdfTyped h ma S gnsfGrO MonthQ Day Year <br /> Taanaperter2PimediTypedpamn 5;ratat - loot$ yDay Year <br /> rte- (.} t� �t i r ✓ [L' IJ <br /> 18.Discrepancy <br /> lea.Diswpnn4y Indleauan Space ❑ quantity ❑Type ElRasldue Elpander pejenuon ❑Fuft Ral"b n <br /> Manifest Reference Number. <br /> 18h.A1lamatn Facility(qr Generator} U.S.EPA ID Number <br /> C? <br /> LL Facility's Phe^e: <br /> 18c,S gr Q urn OA€tamate Facllity(or Gararalori Month Day Year <br /> 4 <br /> 19.Hazardous Wa-a a Reprt Managemem Method Codes(i.e.,codes forha2a(dous Vraslo treattneni,disposal,and racycling systems) <br /> in <br /> to <br /> 20.Do5lgnaled Facllihy Q,.rw or Operalor.Certification of receipt of hazardaus materials covered by the rnanife9qq0taftsnoted in Item lea <br /> P;Entsdt ,pe Nem e nn s Si aEE;r h4 Day Year <br /> CU1 <br /> EPA Form B0-22 NR tit 3.05) Prevl6u5 editions are'obsolete. -1013= 1?'�}A;' D F� ( I''V TO D�STI ATI€ N S ATI;(IF REQUI F-D) <br />