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Please print or type.(Form,Besigned for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST G 57 209-944-5714-2002 014783201 JJK- 5.Generator's Name and Mailing Address Generators ite Address(if different than mailing address) BELKORP Ag. 46 1120 CHARTER'A'AY - P.O.BOX 6059 STOCKTON,CPQ STOCKTON,CAA 95206 Generators Phone: 209-9"-5714-2002 6.Transporter 1 Company Name U.S.EPA ID Number George W.Lowy,Inc. ® CAROM7019 7.Transporter 2 Company Name U.S.EPA ID Number 8.Desyn�I dEF�gi[I �K ®SSiitee ANddress U.S.EPA ID Number 20DO ALAMEDA St. `s nii�li i3 wt COMPTON.CA 90222 Facility's Phone: 310-537-7100 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. o X 1. NA190 WASTE FUEL OIL FLAMMA19LE UQUID ,3 , PGIII (W01) DM G 212 z 2. w c� 3. E11712016 4. AR ; FAIT 14.Special Handling Instructions and Additional Information ERG;r#128 USE GLOMES INVOICES 15. GENERATOR'S/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, marked and Iabeled/placarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. 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. Generators/ Printed/Typed Name a Si re ` Month Day Year j 16.Intemationa Shipments 6-- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Pdnted/ryped Nam Signa ` Month Day Yea IL N24(J ZZ Transporter 2 Printed/Typed Name Mbnth y Year EY 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number V W Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year ~Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedrryped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)