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Please print or type.(Form designed for use on elite(12- Bch) er) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Numb 2.Page 1 of 3.EmergencyResponse Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST I CAL 0 0 0 3 6 6 211 1 (800)4249300 017791888 JJ <br /> 5.Generator's Name and Mailing Address Generators Site Address(0 diterd than mailing address) <br /> FIRESTONE#028746 <br /> 720 E.HAMMER LANE <br /> STOCKTON CA 95210 <br /> Generator's Phone: 209 951-2403 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ASBURY 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.EPA ID Number <br /> DEMENNO/KERDOON <br /> 2000�V ALAMEDA STREET <br /> COMP ON CA 90222 CAT 0 8 0 013 3 5 2 <br /> Facilit es 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)) No. Type Quantity W1.Nol. <br /> 1' NON-RCRA HAZARDOUS,WASTE,LIQUID(BRAKE FLUID) 343 <br /> a D i G <br /> i <br /> W 2. <br /> 1 <br /> 3. <br /> _._.i_....._.._._._......... <br /> I 1 <br /> j <br /> i <br /> 4. <br /> ............ <br /> i <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800.424-9300 NAERG#981:171 *PROFILE#9B1:375894 BRAKE FLUID <br /> APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT # V <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by line proper shipping nam,and are classified,packaged, <br /> marked and labeledfpiaeamded,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 certify that the contents of this consignment conform to the terms of One attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified In 40 CFR 262.27(x)(if I am a large quantity generator)or(b)(di am a small quantity genera)is true. <br /> reneratcestofferor's Prldec4'f Name ig lure � Monti Day Year <br /> -j 16.International Shipments <br /> 1= ❑import to U.S: ❑Export from U.S. Port of entry/exit <br /> RE Transporter signature(for exports only): Data leaving U.S.: <br /> W 17.TranspoterAcknowiedgmrd of Receipt of Materials <br /> Ej T r rte 1 InT Name i u Signature Month Day Year <br /> N <br /> zd nsporter 2 PdntddMped Nam Signature Month Day Year <br /> h- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> ..J <br /> V <br /> u Facillys Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month DayYear <br /> Z <br /> ILD 19.Hazardous Waste Repot Management Method Codes(i.e.,codes for hazardous waste Geatment,disposal,and recycling systems) <br /> LIJ <br /> 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 /> Printedffyped Nam Signature Month Day Year <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. l7E�lfai`1 if () r.+C;)Lij t )'<:) <br />