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Please print or type,tForm designed for use on elite fl2-pitch)typawriter,) Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS LGenemicrlDNumber 2.Pagaief 3.Emergency Response Phone 4,Manifest Tracking Number <br /> WASTE MANIFEST CAD 0 2 8 2 7 7 0 3 6 1 (800)424-9300, 018529098 JJ K <br /> 5.Generators iryame and Malin Address GarreraWfs Ve Addracs(lfdiferent than mailing address) I <br /> l"IORLL OIL ENVI'ONN;ENTALSERVICES I! <br /> 1300 S-SANTA FE AVE <br /> COMPTON CA 90221 <br /> Generator's Ahrne: 310 886-3400 <br /> 6.7mrsporlera Com nyulama US.EPA:ID.Number <br /> VIORLD IL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7,TraiupOrle2 Company NameWS:EPAID Number <br /> 8. <br /> "V <br /> natetl Faciti Name and Stte Atltlress U.S,EPA 10 Number <br /> �SBURY tyENVI RONMENTAL SERVICE-CERES <br /> 1920 MORGAN RD. <br /> CERES CA 95358 <br /> Facility's Phone: (209)541-1825 CAL 0 0 0 3 9 3 6 8 E <br /> ga. 91b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit. <br /> HM and Packing Group(Nary)) 13.Waste Codes <br /> No. Type Ouentiry WtNol. <br /> 1.NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL 133 <br /> o SOLUTIONS) <br /> 001 TT � G <br /> w <br /> z 2 <br /> W <br /> 3. <br /> 4, <br /> 74.Spedak Handling lnsauctonsandAdditienal information <br /> EMERGENCY CONTACT:CHEMTREC 1-500-424-9300 WOES TER 1 4 "'APPRORIATE PERSONAL PROTECTIVE EQUIPMENT* <br /> EMERGENCY CONTACT CHEMTREC 800 424 9300 *TRUCK# �O ._ <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that the contents ofthis consignment are fully and acmra210t10 <br /> Uabove by thepoperahipping name,art are classified,packaged, <br /> marked and IabeledfplacaMed,and are in all respects in poparcondltlon far transport according to applicable inlarnai anovardmeblel regulations.IfexpadshipmentandIamthePrimaryExporter,I certify that the contents of this consignment co porm to the terms cf the atraceed EPAAckaomodgman ContorI unity ItueNe waste minimization statement identified In 40 CFR 26217(s)(ifI amalargs quantity gonareU tn)(ifI amntity generator)Is true. <br /> GamuclofsrONorp( PdnfadRyped Neme Sg urs Month Day Year <br /> 16.Intema0anal Shipments V - <br /> F Import to U19" <br /> ❑Ex m U.S. Pohphvop <br /> Transporter signature(for exports only): loavfh S.: <br /> W 17.TrensporterAclmowledgment ofRecaipt of Materials <br /> C TranmPoror tmadlrypod Name Signer Month Day .Year <br /> O I <br /> a <br /> n <br /> za Transporter 2 PrintedRyped Name ynaWre t _ Month Day Year <br /> ¢f <br /> 4. 18.Discrepancy I-� I—' <br /> 18a.Discrepancy Indication Space �.Quantity ❑T L]Residue El Rejection Re <br /> .,von <br /> YPe ❑Full Ra ecUon <br /> Manif4*al Referer>edNumber. <br /> Allomnte Faclily(or Gonentako)- U.S.EPA 9)Number <br /> -.r <br /> V <br /> LL Factlly's Phone: <br /> w 1Sc,.SlgnalureofAimmam Facility(or Month Day Year <br /> a <br /> a <br /> q19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 1• 2. 3. 4. <br /> 1 ,y, <br /> 20. ly Designated Facility Owner or Operator:CeNficatlon of receipt of hazardous materials covered by the manifest <br /> climan except as noted In Item 1✓!a <br /> PrinteNfyped Name SlgneWre Moron Day you <br /> EPA Form 8700-22(Rev3-05) Previous editions ora obsolete. DESIGN,IT2D FACILITY TO DESTINATION STATE(IF REQUIRED) <br />