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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) <br /> � Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number �'Fage 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST . v ;; �s 1 c JJ K <br /> 5.Generator's Name and Mailing Address <br /> 1,tti(It;L� wl_ ��CE R Generator's Site Address(if different than mailing address) <br /> 2073 E YOSEMITE AYE. <br /> MANTECA _ CA 95:136 <br /> -Generator's Phone: '9 83x93' <br /> 6.Transporter 1 Company Name <br /> WURLD Oil.ENYIRONMFNTAL SERVICES U.S EPA ID Number <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address <br /> U.S.EPA ID Number <br /> r•jkAituh 5i (cti <br /> COMPTON CA <br /> Facility's Phone: 310)537-710C C A T 4 8 0 0 13 <br /> 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard ClassID Number <br /> HM and Packing Group(if any)) , , 10.Containers 11.Total 12.Unit <br /> 1 No. Type Quantity Wt.Nol. 13.Waste Codes <br /> JUS WASTE, UQu ,,r,WATERSORN.- . <br /> 0 <br /> Z 2. <br /> THIS WASTE STREAM HAS BEEN QUALIFIED <br /> FOR RECYCLING/TREATMENT AT THE <br /> 3 <br /> RECYCLING FACILITY IN COMPTON,CALIFORNIA. <br /> THIS FACILITY HAS THE NECESSARY PERMITS TO <br /> RECEIVE Yo'If;WASTE STREAM AS QUALIFIED, <br /> FG—ENERATOR'SIOFFEROR'S <br /> nstructions and Ad Itlonal Information <br /> Y- ( i. ( _l -/, X �f <br /> CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are Gassed,packaged, <br /> marked and labeledrelacarded and aro in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter.I;enify that the contents of th,s consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste mlmmizallon statement identfied in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generalcr's/Offeroris PrtnteWTyped Name Signature <br /> Month Day Year <br /> 16.International Shipments rr <br /> Z u Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): — <br /> Date leaving U.S.: <br /> L 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed[Typed Name Signature <br /> aMonth Day Year <br /> rn <br /> ZTransporter 2 Printed/Typed Name <br /> H Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space II�� II�� <br /> u Quantity u Type ❑Residue ❑Partial Rejection <br /> 1 ❑Full Rejection <br /> Facility t <br /> 18b.Alternate Manifest Reference Number:� rty(or Generator) <br /> U.S.EPA ID Number <br /> U <br /> Facility's Phone: <br /> Z18c.Signature of Altemate Facility(or Generator) <br /> Month Day Year <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> W 1 <br /> 2. 3. 4. <br /> 20.Designated Facility Owner or Operator,Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature <br /> Month Day Year <br /> EPA Form 8700-22(Rev.3 05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO GENERATOR <br /> Print Nlnm— _—' ---- - L �11 t <br />