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Please print or type.(Form designed for Use on elite(12-pitch ter.) <br /> UNIFORM H 1.Generator Form Approved.OMB No.2050-0039 <br /> AZARDOUS ID Number 2. <br /> WAE Page_19f `3:Emergency Response Phone 4.Manifest Tracking Number <br /> STMA�JIFEST -` �- <br /> enetorame ana - <br /> CAL0003687 70 1 424-93W 0�� a 31190 JJK <br /> 5,Gras Nd Miling Address_ �--�"GPnefator's SifeAddress{if diRerent than mailing address) <br /> — OeRI'IFlED COLLI"CENTER - <br /> 2073 E.YOSEMITE.Aw <br /> Generatois�Pho�CA CA 953 <br /> ne 091$ 93D0 .36 . <br /> 6,TranspbttertCompany Name" <br /> WORLD OIL EIMROMINIMM sERVIM U.S.EPA ID Number <br /> 7.Transporter 2 Company Name DAD 0 2 8 2 7 7 0 3 6 <br /> U.S..EPA ID Number <br /> 8.Designated Facility Name and Site Address <br /> WORLD OIL RECYCLING U.S.EPA ID Number <br /> 2000 k ALAMEDA STREET <br /> GOMKON CA 907222 <br /> Facility's Phone; ay A;_ CAT 080013-352 <br /> 9a. 9b,U.S:DOT Description(including Proper Shipping Name,Hazard Class,ID Number, <br /> HM and Packing Group(If any)) 10.Containers 11.Total 12.Unit <br /> 1 <br /> No. Type Quantity Wt./Vol, 13.Waste Codes <br /> c UN1263, WASTE PAINT RELATED MATERW_3,PGII f <br /> t— <br /> w 2 / D M S G 343 1 I <br /> + l <br /> 3. <br /> I <br /> 4. <br /> '14.Special Handling Instructions and AddiNonallnformation i <br /> -EMERGENCY.CONTACT':CHEMTREC 1400-424-930()WOES TERMINAL:CERESCS NAERGO 951:128 *.PROFILE#901, <br /> 449546 PAINT/THINNER/SOLVENT * *APPROPRIATE PPE EQUIPMENT <br /> 15. GENERATOR'SlOFFEROR'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, <br /> marked and labelef/placarded,and are in all respects in proper condition for transport according to appltoable intern tional'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 the attached EPAAcknowledgment of Consent, <br /> I certify that the waste minimization statement identified In 40 CFR 262:27(a)(if I am a large quantity generator orb (If I <br /> Generator's/Offeroe'.Pdnfedfryped Name ).. O(- �ma�ma�quantity generator)is true, <br /> Signature Month Day Year <br /> 16 II ` <br /> /6:IntematidnaI Shipments <br /> ~ ❑Import to U.S. Export U.S.Z Transporter signature(for expo6 only): rt from Podo(erdry/exit <br /> Date leaving U.S.: <br /> ul <br /> 1,7.TransporterAcknowledgment of Receipt of Materials <br /> W Trans 1 Printedffyped Name . <br /> r� <br /> Signature <br /> U3 <br /> 9 Month Day Year <br /> Z.transporter 2 Printed(ryped Name <br /> Q, Signature <br /> Month Day Aar <br /> 18:Discrepancy <br /> 'i <br /> 18a.Discrepancy Indication Space <br /> ❑ Quanfi{y ❑Type ❑Residue <br /> _ ❑Partial Rejection ❑Full Rejection <br /> 18b.Alternate facility(or Generator) Manifest Reference.Number. <br /> d U.S.EPA ID Number <br /> i Facility's Phone: <br /> u18c.Signature orAltemate Facility(or(3enerator) <br /> Month Day Year <br /> Ll 19.Hazardous Waste Report.Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,,and recycling systems) <br /> 3 2.. <br /> 3. <br /> 2iC;FNPRATr1= <br /> fication of receipt of hazardous materials eo4eied by the manifest ezceptas,nded m Item rintedlTyped Name Signature}� oY MonthDay Year' ` �i 1 e A Form 8700 22(Reu.3-05) Pr@viouseditions are obsolete. DESIGNATED FACLITY TO STATE(IF REQUIRED) { <br /> I <br />