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Please print or type.(Form designed for use on elite(12-pitch)l miler.) Form Approved,OMB N0.2050-0039 <br /> UNIFORM <br /> HAZARDOUS i.Generator ID Number 2.P e 1 of 3.Em <br /> errcy se Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST c a l o 0 01 x 4 3 0 7 (to)dzs3oo 016870129 JJK <br /> 5.Can amtats.Namean�taEma,Address - Generators Site Addmss(Inamorenl Man maibng address) <br /> 220011 EE ORCHARD STREET <br /> HAMMONTON NJ 08037 1401 SOUTH CHEROKEE LANE <br /> Genemiors Phone: 209 3650175 LODI CA 95240 <br /> e.Trans 0DRLD"V12 EMIRONMENTAL SERVICES Us.FLp� 61`8 2 7 7 0 3 6 <br /> 1.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Dasignj1g F�cikd7; gilggdtlrass US.EPA ID Number <br /> 2000 N. <br /> AALAAMnEE DDA STREET <br /> COMPTON CA 90222 CAT080013382 <br /> Facility's Phone: (37.0)537-7100 <br /> ga, 91b.U.S.DOT Description(Indudng Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> HM and Packing Graupidany)) Ouarnial WUVO12. t 13.Waste Codes <br /> No. Type Ouantiry WtNaL <br /> z <br /> 1.NON-RCRA HAZARDOUS WASTE,LIQUID(BRAKE FLUID) 343 <br /> l DM 3 G <br /> z 2. <br /> W <br /> 3. <br /> 4, <br /> 14.Special Handling instructions andAdditional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424.9300 WOES TERMINAL:CERES CS *PROFILE#981:432037 BRAKE FLUID <br /> *APPROPRIATE PPE EQUIPMENT a-b/ <br /> 15. GENERATOR'BIOFFEROR'S CERTIFICATION:I herebydedere Matthe contents of this consignmentare fullyand accurately described above by the proper shipping name,and am dassified,packaged, <br /> marked and labeled/pfararded,and are in all respects lnpropercondilon forbansponacordog toapMicable imemadmmlantl national govmrom Watiom.lfwpodsNpmentmdlamthe Primary <br /> Exporter,I certify that the wrtents of He consignment conform to the terms of the attached EPAAdmowledgmeat of C <br /> 1 a <br /> I cediythat{he waste miNmhafion statement identified in 40 OFR28227(s)(If I am a large quantity generator)artb small ntitygenerata)is We. <br /> GenemforslOtfercr 'ntedljyp@d Name Sigrreto Month Day Year <br /> IlV J\-•yl\ fUV1 A 0 l <br /> 18.Intent nal Shipments <br /> r— ❑Import to U.S. ❑Epodfour U,S. Partofentrytexit <br /> ? Transporter signaWre(for exports only): Date leavirg US: <br /> w 17.TranspodarAcknowledgmerd of ReceiptofMaterials <br /> Tran er1 F"memlyped Nam ._ Signature Monro Day Year <br /> Ex. q <br /> 1 e9 <br /> G TranspoMr2 PdntedlTyped Name Signou Mouth �f Year <br /> oc <br /> Day <br /> r— <br /> 18.Discrepancy <br /> ilia.Discrepancy indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rairstion ❑Full ftejeciion <br /> f� <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(a Generator) U.S.EPA ID Number <br /> U <br /> r¢ Facility's Phomr <br /> 18c.Signature of Alternate,Facility(or Generator) Monty Year <br /> Z <br /> N 19.Hazardous <br /> Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and mcydlng systema) <br /> 0 17 !aC�9 2 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt Of hazardous materials covered by the manifest except as Med in Ilmn Ills <br /> Primed/Typed Nam 9igratae Month Day Year <br /> 1024 o9i 6 <br /> EPAForm87M22(Rev.3-05) Previous editions are obsolete. DESIGNATED FA ILITYTO DESTINATION STATE(IF REQUIRED) <br />