Laserfiche WebLink
Please print or type.(Forth designed for use on elite(12-pitch)typewriter.) ,) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Genemlot IDNumber 2.Pagell of 3.Emergency Response Phone 4.Menial Tracking Number <br /> WASTE MANIFEST CAL 0 0 0 4,07 8 9 5 1 (800)424.9300 014053160 J J K <br /> 5.Generator's Name add Mailing Address Generators Site Address(if different than mailing address) <br /> WEST VALLEY AUTO SERVICE LLC " <br /> 2615 W GRANTLINE RD <br /> TRACY 95304 <br /> Generators Phone 209 836-3464 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ASBURY ENVIRONMENTAL SERVICES CAD 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 /> DEMENNO/KERDOON <br /> 2000 N.ALAMEDA STREET <br /> COMPTON CA 90222 CAT080013352 <br /> Farilitys Phone: (310)537-7100 <br /> ga 96.U.S.DOT Description Including Proper Shipping Name,Harard Class,ID Number, 10.Containers11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No, Type Quantity WIN& <br /> a 1. UN3933,WASTE FLAMMABLE LIQUIDS. N.O.S..(GASOLINE, DIESEL) , D001 DOS 343 <br /> 3, PGIII D IVG <br /> w 2. NON-RCRA HAZARDOUS, LIQUID(OILY WATER) 223 <br /> L D UJ G <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 NAERG#982 :171 *FROM LE'#'981:0412166 GASOLINE AND DIESEL, <br /> 9B2:0607161 OILY WATER * *APPROPRIATE PERSONAL PROTECTIY EQUIPM NT -' <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and am lely described above by the proper shipping name,and are clauified,packaged, <br /> marked and labeledlplacorded,and are in all respects in proper condition for transport according to applicable international antl 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 EPAAcknowledgment of Consent <br /> I codify that the waste minimvation statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(it I am a small quantity,g rater)is We. <br /> Generators/Offerors Printed/Fyped Name SlgnaN Monty Day Year <br /> CSA�G�nc� e'rso� o /v Ito <br /> 16.International Shipments ❑ port to U.S. <br /> Import ❑Export from U.S. Pon of en exit: <br /> Transporter signature(for exports only). Dale leaving U.S.: <br /> r1! 17.Transporter Acknowledgment of Receipt of Matenals <br /> w <br /> K Transpo r 1 PnntedRvped.Numc- Signature M,ontnth Day Year <br /> M mnsDorter 2 Pnntedli ed Name nature Month Day Year <br /> a <br /> rr <br /> t18.Discrepancy <br /> 18a.Discrepancy indication Space ❑ Quantity ❑Type El Residue LJPartial Rejection t; ❑Full Reisman <br /> Manifest Reference Number. <br /> 186.Alternate Faglity(or Generator) U.S.EPA ID Number - <br /> J <br /> U <br /> tai <br /> Fri Phone: <br /> w 18c.Signature of Allendale Facility(or Generator) Month Day Year <br /> G <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(Le,,codes for hazardous waste treatment,disposal,and mcyding systems) <br /> C 1 3. 4. <br /> l <br /> 20.Designated Facility Omer or Operator.Cedrmlion of receipt of Irmi docs materials covered by Bre manifest except as noted In Item 18a <br /> Printed4yped Name Signi Month Day Vaar <br /> EPA Form 8700-22(Re 3 5) us editions are obsolete. DESIGNATED FA TY 76'DESTINATION STATE (IF REOUIRED) <br /> 12308.2199 <br />