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Please print or type.(Form designed for use on elite(t 2-pitch)typewriter.) Form Approved,OMB No.2050-0039 <br /> UWFORM HAYAROOUS 1•Generator Ip Number 2.Page 1 of 3,Emergency Response Phone 4,Manifest Tracking Number <br /> WASTE MANIFEST J J K <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> CERTIFIED GO<<.LI.Wt?` 'ENTER <br /> 7710 MURRAY DRIVE <br /> STOCKTON CA <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name U.S.EPA IB Number <br /> RI.D OIL ENVIRONMENTAL SEFMCE5 —' 028277036 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> 2000 N.ALAMEDA STREET <br /> (%0A0VT,9N CA 9022:;' <br /> Facility's Phone: !3lili1Ch-1 CAT©8 O O 2 3 3 8 <br /> ga. 9b.U.S.DCT Description(including Proper Shipping Name,Hazard Ciass,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> 1 N011 IL2ARDOUS WASTE, LIQUID(WATERBORNE PAINT) 331 _� <br /> 9 1 G <br /> 2 LItV1263,WASTEPA � asxicall , ! ,,a,rr� aax-�, , <br /> 3: <br /> NON-RCRA HAZARDO U FORD.ECYCiGITIREATV,11�T;ATTliE <br /> SOLUTION) DeMENNO/KERDOON DBA[)WORLD Oil- <br /> RECYCLING <br /> ILRECYCLING FACILITY 1N COMPTON,CALIFORNIA, p M <br /> 4' RL-CrzIVIE,,V"OUFI V'ti ASTE' F-AM AS QUALIFIED, <br /> OUR EPA NUMBER IS CATO30013352 <br /> 14.Special Handling Instructions and A ftional Informatipn, ' <br /> EMERGENCY CONTACT:CHEMTR€C 14MO-4249300 WOES TERMINAL:CERES CS NAERGN 91171,982,128,91M:171, <br /> 91171 *PROFILE 0 981:446432 WATERBORNE PAINT,911455026 <br /> VENT 983:455027 A1rTIIFR EZE, <br /> Ofl W�ttF_# k: PoROssq qTE opo FC)t.11FPo1�*)� C�� � 53 -_S.K <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this oonsignmert are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generatoc'slOfferor's PrintedlTyped Name .Signature Month Day Year <br /> -J 15.International Shipments <br /> z ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> 7ransporter signature(far exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materiais <br /> LLI <br /> Transpotter 1 Printed/Typed Name SignatureX, Month Day Year <br /> to LA <br /> Q Transporter 2 PrintedlTyped Name Signature L Month Day Year <br /> M <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space ❑ QuantityElT e ❑Residue ❑Partial Rejection <br /> Type 1 El Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> C) <br /> Facillty's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2, 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted intern 18a <br /> Printed Typed Name Signature Month .Day. Year <br /> EPA Farm 8700-22(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />