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Please prrnt of type.(Forrri,designed for use on elite(12-pitch)typew"ter) ,. •' Form Approved:OMB No.2050.0039
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<br /> UNIFORM HAZARDOUS
<br /> 1'Geiretalor ID Number "' 2,Pagett of 3:Emeidnhcy Response Phone 4.Manifest Trxcis_ing Number
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<br /> WASTE MANIFEST it e c3 ,it 3 rs. ( s;3}f ?a, k. tT ., e s :f'`° >
<br /> 5,Generator's Name and Mailing Address Generator's Site Address(if dilfooml than mailing address)
<br /> PE P DOYS 4015-6-12
<br /> [ c"lsYTi? f`JSV� k1:i 02037 1401 SOUTH
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<br /> LAME
<br /> Oeneralor's Phone: f a z 1 LODf
<br /> 6.17an3poder 1 Company Name U.S.FPA ID Number
<br /> WORLD D 0`R rep P $th 15
<br /> 7.Transporter 2 Company Name U.S.EPA ID-Number
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<br /> &Designated Farality Name and$4o Address U.S.EPA lD Number
<br /> 000 f'4.ALAAR_ A;wtt;'cl kf
<br /> 00 0 0 13 4'6
<br /> FacllftysPhone: f 33.0),r.E1 7,7:x(0
<br /> ga, 9b,U.S,DOT DescripPon(including Proper Shippfng Name,Hazard Class,19 Number, 10.Containers 11.Total 12.Unit 13.Waste Codes
<br /> HM and Packing Group[if any)} No. Type Quantity W(.Nol.
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<br /> THiS V%1A- F.SFREAM HAS ACEN OUALIFIED
<br /> DetviEm NO/KERDOON DBA WORLD OIL
<br /> #=,EC1'CLING FACILITY IN COMPTON,CALIFORNIA,
<br /> THIS FACILITY HAS THE NECESSARY PERMITS TO
<br /> 4.
<br /> OUR EPA NUMBER IS CAT080013352
<br /> 14.Special Handling instructions
<br /> f P-0 1kIly F p ,� ., 3, a O 1 2 .V" t;4f`I.�"e"TERMINAL:�'EM' as 3 0 S9"1^ 14,32 �I. R a
<br /> �Cafs.i-�i I,�eNC �J£�9i�-��?:?t +,i7 f� ti l��i� .A.^ 1€f"=-r ^s ;,'�'3'-��iss.,e..�^..- -sr�C'tr..: .J tt FILE �.1�,. e. l .7 ��.yy �F��h:. �y 1�f
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<br /> 15, GENERATOWS/OFFEROR'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;.
<br /> marked and labelodfplacarded,and are in all respects In proper condition for transport according to applicable international and national govemmantal regulations.If export shipment and I am the Primary )
<br /> Exporter,.)certify that the can€eels of This consignment conform to the terms of the attached EPA Acknawiedg�r€enl of Consent.
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<br /> I certify Iha)the waste minlmlzagon statement ldentlfied in 40 CFR 262.27(a)(If I am a large quantity -r(b)(If t arJr asmall'quantllyyenemtor),Is[fee.
<br /> GeneralorisTlor's PrintedlTyped Name W� ( n lir€e,,r ' T Month .Day Year
<br /> Ilk' I Lill
<br /> M Intemalfanaf Shipments g coy_
<br /> H ❑Impo€t to U.S. ❑Export from U.S. Portaf entrylexit.`
<br /> Transpo€ler signalard(far exports only): Date leaving U,S,:
<br /> Ce 17,TranspoderAcknavladgmentofReceipt ofMaterials
<br /> Transporter 1 PdnledlfypedNamegg Signalure, r Month Day Year
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<br /> Z Tansporter2PrintedlfypedName Signature Month Day Year
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<br /> 18,Discrepancy
<br /> 18a,DlscrepancylndfcalianSpace ❑ Quan[fly El Type RosduPartial Refection ❑FwRaJec€ion
<br /> Manifest Reference Number
<br /> 18b,Alternate Faclllty for Generator) U•S.EPA ID Number
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<br /> Facility's Phone:
<br /> W 18c,Signalure o€Alternale Facility(or Generator) Month Day Year
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<br /> 19.Hazardous Waste Report Management Method Codes(Le.,codes lot hazardous waste treatment,disposal,and recycling systems)
<br /> � ij 2. 3, 4,
<br /> 20.Designa(eed Facility avneror Operolvr.Certification of receipt of hazardous materials covered by the manIfest except as noted In flare 18a
<br /> Printeydityped1Name• j{ Signature [JJ/ Moonthh' �DDay Year
<br /> s+�._..- 1�t T Y ( I }• I rf�f 1 �r(,) _r `^� i.J 1 Es ti
<br /> 'A Form 8700.22.(Rev.3-05) Prevlous editions are obsolete. DESIGNAT5D FAOILITY10 GENF-RAT � 3
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