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+fi <br />Please print or 6e. (Form designed for use on elite .(12 pi(ch) typewriter.) <br />V <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700.22 (Re4.. 3-05) Previaus!oddlons are obsolete. <br />DESIGNATEQ FACILITY TO GENERATOR STATE (IF REQUIRED) <br />V <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />2. Page 1 of VErnergimey Response Phone <br />4. Manifest Tracking Number '7 <br />0 0813 5 3 1 AJ K <br />WASTE MANIFEST <br />C A L 0 0 0 3 1 9 4.. S 9 <br />1 20a 4.2 �' 9300 <br />1 <br />5. Generator's Name and Mailing Address Generator's Site Address (If different than mailing address) r <br />WEST VALLEY AUTO SPA AND LUBE - W 197 - <br />„--2615 W GRANTLINE ROAD <br />TRACY CA 964 <br />Generzlor's Plume: -' 209836.4001 <br />6. Transported Company Name U.S. EPA ID Number <br />ASBURYEWRONNENTALSERVICES C A D 0 2 8 2 7 7 0 3 6 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8. Designated Facility Name and Site Address ' U.S. EPA ID Number <br />DENENNOIKERDOON <br />2000 N. ALANEDA STREET <br />CONPTON CA 90271 C A T 0 B 0 0 1 3 3 5 2 <br />Facility's Phone: 0101537-7100 <br />ga <br />91b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing GmuR, (if any)) <br />Quantity <br />WtNo6 <br />1. <br />W <br />NON-RCRAHAZARDOUS WASTE, LIQUID (OILY WATER) <br />2 S` <br />223 <br />rj <br />G <br />Liu <br />2. <br />W <br />I <br />3. -` <br />, <br />1 <br />4. <br />r^. <br />14. Special Handling Instructions and Additional Information -. <br />ENIERGENCYCONTACT:CHEMMEC 14300-424-MIMNAER049B1:171"PROFILE#981:031711OILYWATER'PO# <br />Al 10133097'APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br />15, GENERATOR'SIOFFEROR'S CERTIFICATION: 1 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 Iabetedlplacarded, and are In all respects in proper condifion for transport according to applicable International and national governmental regulations. If export shipment and I am the Primary <br />Exporter, I certity that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br />I certify that the waste minimization staterpent identified in 40 CFR 262.27(x) (ff I am a large quantity generator) or (b) (tt small quantity genarator) is We. - <br />Generator'JOfferofs Printed7Typed Name Signatu Month Day Year <br />-J <br />16. International Shipments <br />-❑Importto U.S. ❑Export from U.S. Port of entry/exit <br />Z <br />Transporter signature (far exports'only): Date leaving U.S.: <br />w <br />17. Transporter Acknowledgment of Recelptof Materials <br />Transporter 1 Pdntedlryped NarOq t` Signature / Month Day r <br />(\ n11�� J 2Y <br />a <br />t„J <br />QC <br />Transporter 2 Pnnted7fyped Name V Signature Month Day Year <br />F-- <br />} <br />18. Discrepancy , <br />18a. Discrepancy Indication Space ❑ Quaintly ❑ Type i ❑ PaNal Re ❑ Full <br />El lection Rejection <br />Manifest Reference Number. <br />i8b. Alternate Facility (or Generator) f, U.S. EPA ID Number <br />J <br />U <br />LL <br />Facility's Phone: <br />w <br />ISc. Signature ofAltemate Facility(or Generator) <br />Month Day Year <br />Q <br />Z <br />y19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste Vestment, disposal, and recycling systems) <br />G <br />D <br />2. <br />3. <br />4. <br />FDDesignatedFacility Owner or Operator. Certification of receipt of hazardous. materials covered by -the manifest except as noted in Item 18a <br />- Signature Month Day Year <br />U O -cV l/ <br />EPA Form 8700.22 (Re4.. 3-05) Previaus!oddlons are obsolete. <br />DESIGNATEQ FACILITY TO GENERATOR STATE (IF REQUIRED) <br />V <br />