Laserfiche WebLink
pleas©print or type, Form designed for use on elite 32 Itchtypetvdter) Form Approved.OMB No,2050.0039 <br /> ONiFORMHAZARDOUS 1.10momtcrioNumber 2.Pago1O 3.Emergency Response Phone hanlfes racktne umberr� r <br /> ;1 i1gASTE MANIFEST ', :r•C A R 0 0 0 2 8 9118 1 .(800 4249300 O 17 6 9 F.213 JJ K <br /> 5,1i3 eratorsNameandMallinggddross 00noialofsSite AddressQf erentthanmailingaddress) <br /> PICK N PUL[.#80 <br /> 3927.CLARK R. <br /> STOCKTON CA 95218 <br /> Generator's Phone: <br /> 6.Transporter t Company Name U.S,EPA ID Number <br /> WORLD Olt.ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7:Transporter 2 Company NameEPAtD Number <br /> j <br /> 8.%signaled Facility Name and Site Address U.S.EPA ID Number <br /> 3 DEMENNO J KERDOON <br /> 2000 N.ALAMEDA STREET <br /> COMPTON CA 90222 CAT 08001$352 <br /> Fadillys Phone: <br /> ga; 9b.U.S.DOT Dascripgon(Induding ProperShlpptng Name,Hazani Close,fO Number, 1Q.Contalnera 11.Totat 12.Unit 93,Waste Codes <br /> HM: and peoldngGroup Ofsny)) No. Type Quantity Wt.lVol- <br /> `:' _ 1'NON RCRA HAZARDOUS WASTE.LIQUID(BRAKE FLUID) t ! � <br /> J 0M <br /> LU <br /> 2, <br /> co <br /> Li <br /> 4 <br /> t <br /> �14•spec}alHendiinglnsuucconsandAddNorratlnlonna on <br /> EMERdtkdY 6NTA0T r014EMTRF-O 1.800-424-9300 WOES TERMINAL:CERES 05 NAERO#9E1:171*PROFILE#9131 <br /> '4o%04 POKE' FLUID* *APPROPRIATE PPE EQUIPMENT LPrt <br /> 35 :Gf NERa70ft'51,QEFEREIR'u�C tiTIFECA710t1:.I hereby dedaro that the contents of this consignment are lefty and accuralelydde-scl4ed above by the proper shipping name,and are classl0ed,packaged, <br /> meNted and labeledlpl cal ted antl eteih all4o5Peas in proper condition for transport acsordlog to applicable tntemollonatand national governmental regulations,if export shipment and I am ilia Primary <br /> Exporter,)raiUty itiatthe�dhlentS.dithis cdnsignment conlotm iothe terms of the adsched EPAAcknoWedgment of Consent. <br /> ,I;cerUry that the waste m riimtz9gdn'stetemeat Identified In 40 CFR 262.27(8)(If t am a targe quantity generator)or(b)(dl am a small quant ty ganorater)is We. <br /> an to Off rs Printedf typed t e Ign lure„ th Day, Year <br /> It 2JAIIC <br /> a 16.ntematlona S ip is <br /> r. ampgrttoU,S ❑PSgwttftgmU.5; Portoferiry/ext <br /> Tran sPodersignature(for exports only): Date leaving U.S,: <br /> .17, sponarAckngvdedgmentofReceiptofMa(arida <br /> Ttanspo 1 dntednyp Name Signature Mont. ay ear <br /> ansponer2Pr tedflyped am Sgnarirre , onih Day Year <br /> 41screpancy <br /> 16a Discrepancy tnd cation Space c 11 quantity ❑Type [1Rad'ue ❑Partial'Reladon ❑ra Re action <br /> r <br /> i Manifest Reference Number <br /> 180itemate Factiity or Generator) U.S.EPA ID Number, <br /> . Faafty'sPhone <br /> 18c,Slgnatureo temataFaclllty(orGenerator} Mo Day Year <br /> 19.11,rardous.WasteReport ManagemaptMelhod,Codeso,e„eadesfor hazardous waste treatment,dlspbsal,and recydlr�iystems) <br /> 20,t)esignatad Fa rOxer or Operator,Coffiation of receipt of hazardous materials covered by the manifetit except as riled In Item ilia <br /> PrintTyped Name Signature Mont Day Year <br /> tbrow- I L7-LA <br /> EPAForm 8700.22(Rev,3 R Previaus'editrons are'obsoleie, DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />