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•s6911'sialieq swruv uwr�rvr-r.1., -s6eq ogseld jo'iaded'ylo)o'Datong=VU - !ew uad Sulo uuy 1lonjt dwn0=10 Paeq umop ssaid—pasn eq osle S213NId1NQ0 d0 S3dA1--1319d1 alggedwoa osle sl golgm aajpmadl.(allla)gal!d-Zl a uo asn uol pau6lsap uaaq seq uu0i slyl 1 jauleluoo to adkl ag1 Jol(Molaq) •uuol slgt 6uga)dwoo aAAgeq suogonasui rye peaa 1121111-3 UNIFORM HAZARDOUS 1 1.Generator ID Num a Page 1 of J.Emergency Response rnane _ WASTE MANIFEST ,c L u 0 3 8 8 7 7 0 ,.-P JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) GERTit- (;OLLISK)N CENTER 2073 L r CSEMITE AVE. MANTECA CA 95W Generator's Phone: 109 830-OW 6.Transporter 1 Company Name U.S.EPA ID Number ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 1 7 0 3 6 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number A)U N.AIAMLUA:iIKILL f 4APTON GA 90222 CAT" P "•-1 13 ,' 52 Facility's Phone: (31011537-7100 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./Vol, 1' IN1994. SviiSiE FLAMMABLE LIQUID.N.0.3.,(PETROLEUM , 343 ASTiLLATES). 1, PG It tea' R z 2. THIS WASTE STREAM HAS BEEN QUALIFIED FOR RECYCLINGITREATMENTS AT THE r 3,, e 1KERDOON DBA WORLD OIL RECYCLING FACILITY IN COMPTON,CALIFORNIA, THIS FACILITY HAS THE NECESSARY PERMITS'rO A, RECEIVE YOUR WASTE 4. OUR EPA NUMBER IS CATOBOO13352 hr n if 14.Special Handling Instructions and Additional Information i} LME%ENCY CONTACT :CHEMTREC 14WO-424-9300 WOES TERMINAL'CERES C9 *PROFILE ri 9B1 :423710 PAINT THINNER APPROPRIATE PERSONAL.PROTECTIVE FOMPMENT ' (/ i/ t Z „ 15. GENERATOR'SIOFFEROR'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, n. marked and tabetedlplacarded,am are m all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of,his consignment conform to the terms of the attached EPA Acknowledgment 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. Generator's/Offerors Pdntedfrypec Name Signature Month Day Ycar t 1 1 16 International Shipments ❑Import to U.S. LlExport from U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: Or W 17 Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedlTyped Name Signature Month Day Year O a QTransporter 2 POntedffyped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Cuantity Type ❑ j ❑Full Re' ❑ El Partial Reaction lection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1, 1 7. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedffyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR