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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Trackin Number WASTE MANIFEST CAR 0 0 0 0 7 7 8 0 0 (NO)'42111-9300 t�215 4�13 JJ K � 5.Generators Name and Maili Address Generator's Site Address(if different than mailing address) DELTA TRMNINTER 10182 S.HARIAN FRENCH CAMP CA 95231 Generator's Phone: 209 983-2400 6.Transporter 1 Company Name U.S.EPA ID Number WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 1 0 3 8 7.Transporter 2 Company Name US:EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number WORLD OIL RECYCLING 2000N.A EDA STREET re cATOA0013352 Facility's Phone: 310)537-7100 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity WI.Nol. 1-RQ.UN1993.WASTE FLAMMABLE LIQUID.N.O.S.. _ 0001 D018 343 0 (GA90UNE/OIESEL).3.PGII DM G z 2. W f, 3. 4. 14.Special Handling Instructions and Additional Information EMERGENCY CONTAC'1 .ik .iii 1-800-424-9300 0 WOES TERMINALL"CERES CS NAERG#981 '128 P90MLE 0 9BY n>•^nqr-r•r,r0t_IPIC:•r,tF^FL MIXMRV sk *aPOP:<,^MATE PPE EQUIPMENT 15. GENERATOWSIOFFEROR'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, marked and labeled/placarded,and are in all respects in proper condition for transport arcording to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifI am a small quantity generator)is true. Generatoe'sK]fleror's PrintedlTyped(Jame S a:a e:•_ Month Day Year _j 16.International Shipments 1- 1-1 Import to U.S. ❑Export from U.S. Port of entry/exit Z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signaiue Month Day Year Transporter 2 Printedffyped Name Signature Month flay Year Q 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residuej El Full Rejection ❑Partial Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number _J V LL- F a,ielty's Phone: W 18c.Signature of Alternate Factiity(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4- 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a rrtntedfFyped Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY