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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 <br /> 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone <br /> =017696022JJ <br /> ing Number <br /> WASTE MANIFEST CAD028277036 1 (800)4'24-9300 K <br /> 5.Generatoes Narm and MatiIng Address Generator's Site Address(if different than mailing address) <br /> WORLD OIL ENVIYONMENTAL SERVICES <br /> 1300 S.SAN FA FE AVE <br /> COMPTON CA 9022i <br /> Generator's Phone: 310 886-3400 <br /> 5.Transporter 1 UrrPany Name U.S.EPA ID Number <br /> WORLD UIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Cw pany Now U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> ASBURY ENVIRONMENTAL SERVICE-CERES <br /> 1920 MORGAN RD, <br /> CERES CA 95358 CAL000393680 <br /> FadtltVs Phone: (209)541-1825 <br /> 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> rr 1 NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL 133 l <br /> 0 SOLUTIONS) 001 T TG ` <br /> z 2. <br /> LU <br /> 0 — — — <br /> 3 i <br /> 4 <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT CHEI,ATREC 1-800-424-9300 WOES TERMINAL: UNION CITY CS 11,APPRORIATE PERSONAL PROS f-CTIVE <br /> EQUIPMENT-EMERGENCY CONTACT CHENITREC 800 424 9300 -TRUCK# <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 labeled/placarded,and are in all respects in proper condition for transport according to appllca61el*nat on and nalional 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 EPAAcknowledgtn8ht of C 41. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator}❑r(b] f am a small quantity generator)is true. <br /> Ga eratae xff roes Finw-17vt ed Name eg to Month Day Year <br /> 16.International Shipments <br /> F ❑Import to U.S. ❑Export from U.S. Pono ntrylexit: <br /> Transporter signature(for exports only): Date aving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> T� 113' Nama n ra Month Day Year <br /> � VL Ir <br /> C <br /> NE Transporter 2 Printedaype Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manlfest Reference Number: <br /> 18b Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> L Fa6lily's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1 y \ 1, ` 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 /> Prlmo&Typed Narm Signawre Month Day Year <br /> bV,44 �Z ZS If3 <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete, DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />