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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) —7Form Approved.OMB No.2050-0039 <br /> UNIFORM ILVARDOUS 1.Generator.ID Number 2 Page 1 of 3.Emergency Response Phone 4.ManlleslTraddng Number <br /> WASTE MANIFEST CAL 0 0 0 3 6117 5 1 (800)424-9300 017792233 J J K <br /> 5,'Wt7AaT4ft' <br /> d'A4'M`6 PAT-NT GenfnWs Site Address(if ddtorent Than mailing address) <br /> 840 E JEFFERSON <br /> ST <br /> STOCKTON CA 95206 <br /> Generator's Phone: 209 981-6956 <br /> 6.Transporter t Co Nanw U.S.EPA ID Number <br /> ASBURYVIRONMENTAL SERVICES I CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transponer 2 Company Name U.S.EPA ID Number <br /> 8 Designated Faofq Name and Site Address U.S.EPA ID Number <br /> DEMENNO/KERDOON <br /> 2000 N:ALAMEDA STREET <br /> COMPTON CA 90222 CAT 0 8 0 013 3 5 2 <br /> FeciliVs Phone: (310)537-7100 <br /> ga. 9b.U.S.DOT Description(nduding Proper Shipping Name,Hazard Class,iD Number, 10.Containers; 11.Total 12.Unit <br /> HM and Paddng Group(d any)) No. Type Quantity WM. 13.Waste Codes <br /> I UN1993,WASTE FLAMMABLE LIQUID,N.O.S(PETROLEUM / D D001 343 <br /> KDISTILLATES),3, PG 11 ( —� <br /> a� DM G <br /> w 2 f <br /> O <br /> 1 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Inform ttlon <br /> EMERGENCY CONTACT:CHEMTREC 1-800-4249300 WOES TERMINAL:CERES CS *PROFILE#981:0306201"1 PAINT <br /> THINNER* *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> 15. GENERATOR'SIOFFERORS CERTIFICATION:i hereby declare$at the contents of Ods consignment am fullyand accuallify described atim by the ptopershipping rame,and are classilled,packaged; <br /> marked and YabeloNpiacarded,and are In d respects in pwpercottam for transport aoowft to app c"Intematioraland rational gawma trial fegulations.I export sfepment and I am Uta pdmaq <br /> ExporterwA <br /> ,I certify that do contents of this eonsignmril conform to the terms of the attached EPAAcimedgment of Consent <br /> I certify that He waste minimization SWOment Identified in 40 CFR 26227(a)(d I rm a large gruanfity geneatar b)(e am a small quantity :reratnr)is 1e. <br /> Ganere"""fen rl aadTyped Name Month Day Yaw <br /> fJ 16.International Shipments ❑Import tc U.S. ❑Export frau'U-11 - rt of entry/edt <br /> z <br /> Transporter signature(for exports eoty): Dab l vft U.S.: <br /> Vanms moaiedgrne90fRece0tofMateriaIsdTyped nS"g� jonlhDay Year <br /> dlfypdNameSIBS MkmUr Day YedrI- <br /> 18.Discrepancy <br /> lea.D•rsetepancy Indicator,Space ❑ouantily ❑Type ❑Residue ❑Peru Rejection ❑Full RejecUeh <br /> Mantfast Refrronce Number. <br /> fhb.Alternate Fatty(or Gonerrtor) U,$.EPA ID Number <br /> J <br /> U <br /> rat Facility's Phone: MMfh 0.iy 1 ar <br /> W 18c.Signature of Alternate Fndkty for <br /> 19.Hazardous Waste Repot Management Method Codes(I.e.,mdm for hazardous waste beatmeat drposal,and recycling systems) <br /> a 1 2. 3. 4. <br /> 20.Designated Facifdy Owner or Operator.Certification of receipt of hazardous mabrlals covered by the tnendest except as noted in Item 18e <br /> Printedrtyped Name SlgneWre Month Day Year <br /> FPAForm8700-?2IRM.3-05)Fteveousedi-mw,cilbv . DESIGNATED FACIUTYTO DESTINATION STATE 11F REOUIRED1 <br />