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;-k —At—% <br />Form Aonroved. OMB No. 2050-0039 <br />crease <br />P11111 LA typo. %VV11" .—Y— r <br />UNIFORM HAZARDOUS 1 4 6 6 5 EI 4 <br />2. Page 1 of <br />3. Emergency Response Phone <br />:3 --) 0 fj <br />4. Manifest Tracking Number <br />FLE- <br />f <br />WASTE MANIFEST <br />L9 [10 <br />011752398 <br />A� qpgt Site Address (!�djrm man me Ning add.) <br />Name a toss %. , <br />TI!TTel8v e n i,.�fffnmc t vr-n 06-2 <br />4627 D3L V114CI DRIVE, <br />F-0- Box 80741 <br />SToc-YTOk4i C;k 55207 <br />Rancho SaIlta 1,1argarita, CA 92688 <br />(84S) 4CiG—Fi20G <br />Generator's Phone: <br />6. Transwr 1 company Name U.S. EPA ID Number <br />BELSHIRE; 1_ CARO 0 01839 13 <br />7, Transporter 2 Company Name U.S. EPA ID Number <br />8. Des'led Factilty. Nam and Site Address U.S. EPA 10 Number <br />Del-renno Kerdoon CAT060013352 <br />2000 N- Alameda St. <br />Compton, CA 90222 <br />Facitil es Phone: <br />go. <br />9b. U.S. DOT Description (Includin; Proper Shipping Nam, Hazard Class, 10 Number, <br />to. Containers <br />11, Total <br />112. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (If any)) <br />Quantity <br />WtJVol. <br />1. UN1202, G;zvolinr- 14ixtiare, w, PG 11 <br />G <br />124 <br />0 <br />Z <br />2. <br />11.1 <br />0 <br />3. <br />4. <br />14. Special Handling Instructions and Additional IngRion WEAK ALL PjATE BESI: 2 9 4 2 8 0 <br />ERG #: 128 PROTECTIVE CLOTHING 7-11 CCN: 61-31710 <br />Gazoline & Water <br />X65i <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of Oft consigner are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and labelediptacarded, and are In all respects In proper condition for transport a=PAV to applicable International and national governmental regulations. If export shipment and I am the Primary <br />Exporter, I certify that the contents of No oonsIlInment conform to the terns of the attached EPA Acknowledgment of Consent <br />I cargly that the waste mirfirnizallon statement Identified In 40 CFR 20227(a) (I I am a knife quantity generator) or (b) (If I am a am~* generator) Is true. <br />GoneratoestOfferor's PrIntefflyped NSig nature with Day Year <br />Larry Hoothart of ame BESI on behalf of generator I is I <br />—.116. <br />ti <br />International Shipments Flimport wEJ us. Export from U.S. Port of enbyk)dt <br />Transporter signature for !K!* only): Date leaving U.S.: <br />W <br />V. TransporterAcknowledgment of Receipt of Materials <br />Transporter I Printe na ureMonth Day Year <br />o <br />Transporter 2 PrIaledflyped Nam Signature Month Day Year <br />18. Discrepancy <br />18a. Discrepancy indication Spare F1 Quantity Type El Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />U, <br />FacURYs Phone: <br />18c. Signature of Alternate Facility (or Generator) Month Day Year <br />19. Hazardous Waste Report Management Method Codes O.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />Uj <br />20. Designated Faciffty Owner or Operator. Certification of receipt of hazardous matedats covered by be manifest except as noted In Item 18a I <br />Printed/Typed Name Signature Month Day Year <br />C <br />EPA Form 8700-22 (Rev. 3-U5) Fremspattions are ousoiete. <br />DES <br />'ISdWLUI-XALI I Y I U Utti I INAI 1UN b [A[ t jlr Kr-WUIKr-U) <br />