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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 Number 1.Page i of 3.Emergency Response Phone 4.INanifast Tracking Number <br /> WASTE MANIFEST - L 0 0 0 3 1213 1 t; c0) X24 9300 a 1 Q 2 3 7 8 6 3 JJ K <br /> 5.GenT12�ftT:Bd IEndSS CENTER Generator's Site Address(f different than mailing address) <br /> 7710 MURRAY DRIVE <br /> S T OC TON CA 952:1.0 <br /> Generator's Phone: 209 830-9300 <br /> S.Transporter 1 Com an Name U.S.EPA ID Number <br /> B"No ar'KIVIRONMENTAL SERVICES CAD 0 2 5 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.DesignFact s U.S.EPA 10 Number <br /> DEMN /KERDOOV <br /> 2000 N.ALAMEDA STREET <br /> COMPTON CA 90222 <br /> CA 080013352 <br /> Facility's Phone: (310)537-7100 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)} <br /> No. Type ©uantity Wt.Nol. <br /> 1. UN1893, FLAMMABLELIQUID. N.O.S., PETROLEUM <br /> � ( DISTILLATES).3 CO=0? D015 � 343 <br /> PG II <br /> i <br /> 3. i <br /> 4. <br /> i <br /> 14.Special Handling Instructions and Addltional Information <br /> EMERGENCY CON TACT: CHEMTREC 1-500-424-9300[DOES TERMINAL:CERES CS x PROFILE#951:100417-04 PAINT <br /> THINNER * *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT 4 Z0Z1 / lt,?O <br /> 15. GENERATOR'SIOFFEROR'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€abeledlplaearded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I ce <br /> ,*Tat the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent <br /> certify t the aste minimization stateidentified in 40 CFR 262.27(a)(if l am a large quantity generator)or(b)(if I am a small quantity gen tor)is true. <br /> 00' <br /> en r`s Prihtedd ad Na Si na / Month Day Year <br /> AE<Z <br /> 6.International Shipments <br /> F ❑Import to U, . ❑Export from U.S. Port of entrylexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> L= 17.Transporter Acknowledgment of Receipt of Materials <br /> /17 <br /> = Tran rt r 1 Printed ped Narrk Signature Month Day Year <br /> C e! a r <br /> za Transporter 2PrintRIT d ame Signature Month Day Year <br /> a <br /> l- <br /> 18.Discrepancy <br /> 188.Discrepancy Indication Space ❑ Quantity El Type ❑Residue E]Partial Rejection ❑FuII Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> W1 1 <br /> 18c.Signature of Alternate Facility(or Generator) Month bay Year <br /> a <br /> z <br /> u519.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1. 2, 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> redName Signature Month Day Year <br /> EPA Form 8700-22(Rev,3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />