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Please print or type..(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Numberage 1 of 3.Emergency Response Phone 0.Manifest Tracking Number <br /> WI�STE MANIFEST CAL 0 0 0 4 1 5 4 6 0 2.P ::.300)424-9300 ®1 t J J K <br /> 5.Generators Name and Mailing Address Generators Site Address in different than mailing address) <br /> TEC OF CALIFORNIA-LOUISE AVE <br /> 2050 E LOUISE AVE <br /> LAIHROP CA yy�jyV <br /> Generators Phone: 209 85&4=0 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> RECOVERY SYSTEM INC. CAR 0 0 01 7 5 4 2 2 <br /> 8.Designated Facility Name and Site Address _ U.S.EPA ID Number <br /> 27-Oc131H5i <br /> YUM.A AZ 85365 <br /> Facilitys Phane: (92P=�:1 i A Z R 0 0 0 515 9 2 4 <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Centel am 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes- <br /> No. Type Quantity WLNoI. <br /> 1., L4A 1 OUS WASTE.SOLID(OILY SOLID. PAPER FILTEFK;1 <br /> 0 352 <br /> 01 qO P <br /> w <br /> z 2. <br /> w <br /> 7 <br /> 3. T <br /> I <br /> 4. <br /> 14,Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1.800-424-9300 WOES TERMINAL CERES CS *PROFILE#981: 162623NRSTEC605 <br /> OILY SO!.I^. "F.vFv aj-F cg K *APPROPRIATE PPE EQUIPMENT <br /> ?1 ?-01AI AX S`� <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment am fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and 1 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 certify that the waste minimization s lament identified in 40 CFR 262.27(a)(N I am a large quantity rata)or(b)(01 am a small quantity generator)is true. <br /> Genera g/Offerors PdntedRyped Name Sge _ Day Year <br /> J 16.Intemabon I Shipments <br /> F0 Import to U.S. Expod from U.S. Pod of entry/exit: <br /> Transporter signature(far exports ony): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> 0 Transporter 1 Printed/Fyped Name SignaN __ Month Day Year <br /> z Transporter 2 PmidectTyped Name - Si natufe <br /> Q g Month Day Year <br /> t18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> r 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Facility's Phone: <br /> Ujj 18c.SignaturedAhemate Facility(or Generator) Monlh Day Year <br /> a <br /> z <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> {} <br /> 1 1 � (( 2 3. 4. <br /> 1 20 Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printisirryped N i Signator§ r 1l. Month Day Yepr <br /> lire �-il �1�l'tiE ) ( <br /> EPA Form 8700.22(Rev.3-05) Previous editions are obsolete. 1 - DESIGNATED FACILITY TO GENERATOR <br />