Laserfiche WebLink
AIDe.(Form designed for use on elite(12-pitch}typewriter.) FormA} hproved.OMB No.2050-6039 <br /> Please printUNIFORM ne 4.Manifest Tracking Kumber <br /> WASTE MANIFEST C A L 0 0 0 3 7 12-13 1 (800);4249300 01817 0 2 8 9 JJ K <br /> 5.Generator's Name and Mailing Address Generator's Site Address(it different than mailing address) <br /> CERTIFIED COLUSION CENTER <br /> 7710 MURRAY DRIVr <br /> STOCKTON CA 95210 <br /> GeneratoCsPhone: 209 478-9971 <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 /> 8.Designated Facility Name and Site Address U.S.EPAID Number <br /> WORLD OIL RECYCLING <br /> 2000 N.ALAMEDASTREET <br /> COMF'TON CA 90222 C A T O 8 0 0 13.3 5 2 <br /> Faciliys Phone: <br /> 9a. 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)) Na. Type Quantity WtfiLL <br /> 1.NON-RCRA HAZARDOUS WASTE, LIQUID,(WATERBORNE PAINT) <br /> � . DM a G <br /> LU <br /> w 2. <br /> UN1263,WASTE PAINT RELEATED MATERIAL.3. PGII D001 F003 F005 <br /> K f D M G 343 <br /> 3.NON-RCRA HAZARDOUS WASTE. LIQUID(ETHYLENE GLYCOL 133 <br /> SOLUTION) D M 1,5 ..G <br /> 4. <br /> 1 14.Spedal Handling Instructions and Additional Information <br /> .EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL'CERES CS NAERG#9BI:171.962.:128.903-:171, <br /> 9134:171 u PROFILE#981:446432 WATERBORNE PAINT,9B2:45502 S. VENT„°�533;455027 ANTI�TEZE,904:4 <br /> /L/ O ��s <br /> 15. GENWTOWSIQFFEROI S CERTOGATiON: Thereby ectare that the contents of this consignment aro fully and aocmtely described above try the proper shipping name,and are classified.packaged, <br /> marked and lal edrdlplacarded,.and are in all respects in proper condition for t:ansport according to applicable international and natonal governmental regulations.R export shipment and I am the Pri nary <br /> EVoder,I certify That the oonkents of this consignment conform to the terms of the attached EPAA&QwWgment of ConsenL <br /> 1 certify that the wasta minimization Statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)Cd l am a small quantity gener4tor)is tree. <br /> ( �7 Mont pay yor <br /> Gen -r'sf4tTeraes.8nnteciffiPO4 we <br /> - <br /> 1yy, <br /> --j. %.International Shlprhants <br /> 1.— ❑Import to U.S. ❑Export fmm U.S. Port of entry/m& <br /> re for ex oris onl Date <br /> 'i`ranspq t¢r�i n ( P y)i <br /> i7.ira sspa;tef�acnowiedgrneruoiReoeipiufivaieriais <br /> Tran 1 Pd itedlT ed N me SignatureMo rix F frldrdh Dajf 1j�f <br /> I 1 _ <br /> tri. - ' Month qa <br /> Tzanspoiter Phnti 3lTyped Artie Signature Y _ <br /> F:. <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Parlfal Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Altemate Facility(or Generator) U.S EPAID Number <br /> U <br /> F.acilitys Phone: <br /> W 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> a <br /> Z . <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes far hazardous waste treatment,disposal,and recycling systems) <br /> mi. . 2. - 3. 4- <br /> 20.Designated Facility Ovmer or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Ba <br /> PrintedfTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-G5) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />