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N 1 <br /> 'lease print or type.(Form designed for use on eiile(12-pitch)typewriter) Form Approved.OMB No.2050-0039 I <br /> UNIFORM HAZARDOUS 1.Genera€or ID Number 2.Page i of 3.Emergency Response Phone 4.Manifest TraaccHng Number <br /> WASTE MAIJIFESI C;�L 0 J d 19 ::;ti 424,030, 0 1 1 4 68540 <br /> S.Generators Name and Mailing Addrmss Goneralors Site Address(if dillarent than mailing address) <br /> Pp COT'S U051312) <br /> 201£OROHAf.D ST REFT <br /> I ir,f,i v'O 1TOPI _S:r=:":N ,f I�Ei?��'=3 Ir l_'?C�I'c" <br /> t � ft.f OLtf�37 :i�,� �, <br /> Generators Phone: <br /> 209$65-0173 L rJi CA 95240 j <br /> 6.Transporter 1 Company Name U"5.EPA lD Number <br /> LJOYI_ 'OIL ENIVIRONIs9ENTvL SERVICE: C A l�D`?3 , 7036 <br /> Company Name <br /> 7.Tmnspafler2 U.S.EPA ID Number <br /> 8-Designated Facility Nafpe and Situ Address U.S.EPAiD Number <br /> i <br /> DEME€VNO/KER?OON <br /> 2000 iV.,';UVAEDASTf'EE(' <br /> COMPTON CA 90222 CAT080013352 <br /> Facility's Phone: (310)537-7100 <br /> ga, 9b.U,S,DOT Description(Including ProperShipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Until 13.Waste Codes <br /> HM and Packing Group Cif any)) No, Type Quan€ity ".1vol. <br /> 11VON-RCRA HAZARDOUS WASTE. LIQUID(BRAKE FLUID) � 343 <br /> 2- <br /> L <br /> ' r <br /> ss <br /> is <br /> 3. <br /> 14.Special Handling Ins1ruo6ons avid Additional Infprin n <br /> EMERGENCY CONTACT,CHENITREC 1800.424-9300 WOES TERMINAL: *PROFILE#9$�1J`X32037 BRAKE l LtllEl * X <br /> APPROPRIATE PPE�QUIPNIENT WZ� <br /> i 15. GENE RAT4R'Slt]FFEfWWS CER4I0:06N:I hereby declare that Ute cantentsa(this consignment are fully and accurately described above by the proper shipping nalrie, id ale asstfied, ctcaged, <br /> marked and label and are In aN respects in propor condition fortrainspote a0wrling to applieable inlematonaland nallonat governmental regulations.Ile rt <br /> xposhtpid'e l a�jd I pm the Primary <br /> Exporter i certify that the contents of this consignment conform to the terms of the attai FPAAclmmAedgment of Consent. \.: <br /> I certify that Ula Virile minlmjzallon stalement'ldentified In 40 CFR 262,27(a)(Ill am a Inge quantity generator)ar(b)(If f am a small gaanU[y generator)is true. <br /> n slOffemPs f?iin(edfTyped;tdama 5 n re a,r hl9dth =Mayr:'"•,Year - <br /> " <br /> i a 1 .International Shipmentsi°. <br /> ❑Import Io U.S. ❑Export from U.S. Part of enlrylexit i <br /> f-. <br /> -- <br /> Date Leaving U.S.: <br /> Transportersignature(forexportsonly): <br /> w17,TranspoderAelcnovAedgment of Recelptof Materials <br /> J�T;rani ed{TypedN e SignatureDay YoaraIO. 0 "G <br /> cs <br /> iz Transporierz dnted(fypedName Signature" Moi€lh Ddy Year' <br /> 4 ' <br /> 18.Discrepancy <br /> 185.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑partial Rejection ❑FuII fiejecllon <br /> Manifest Reference Number: <br /> 1?� 18b.Allemate Facility(or Generator) U.S,EPA ID Number 3 <br /> i <br /> ,U <br /> rQi <br /> Facility:;Phone: Month Day Year <br /> C2 18c.5ignalure ofAlternale Facility(or Generator) <br /> a <br /> 19.Hazardous Waste Report Management Method Codes(I.D.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 4. <br /> CA <br /> [7- . <br /> i 20.Designated Facility owner or Operator.Certilicallon'vf receipt of hazardous materials covered by the manifest except as noted in Item 185 <br /> Printed/Typed Name Signature Month Day Year <br /> i <br /> EPA Form 87oo-22(Rev.3-05) Previous editions areobsotete. DESIGNATED FAGILITYTO DESTINATION STATE(IF Rf~Qtlf�)ED) <br />