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e <br /> i <br /> I <br /> Please p€irit or type.(Form designed for use on elite(12-pitch)typ@wdtai,) Form Approved,OMI3 No.2050-0039 <br /> UNIFORM HAZARDOUS Generator <br /> Generator ID Number 2,Page 10! 3.Erne gency ftasponse Phone 4.Man€test TrestiTng Number <br /> WASTE[MANIFEST CAD 0 2 8 2 7 7 0 3 6 {$QO)424 9300 0 8 o 2 JJ K <br /> 5.Generaiaes Name and Mailing Address Generator's Situ Address(if dlfferenithrin ref ij address) <br /> 3 <br /> WORLD OIL ENVIRONMENTAL SERVICES <br /> 1800 S.SANTA FE AVE <br /> COMPTON CA 90221 <br /> QenoralorsPhone: ' <br /> 310 8815-3400 U.S,EPA Numtrer <br /> s.Trar4orter t�ampany Name. CAD 0 2 8 2 7 7 0 3 6 <br /> WORLD OIL ENVIRONMENTAL SERVICES <br /> 7,Traospprtor 2 Company Name U.S.EPA ID Number <br /> { <br /> a,Designated Facility Name and Slte Address U.S,EPA ID Number 6 <br /> ASBURY ENVIRONMENTAL SERVICE_CERES <br /> 1920 MORGAN RD. CA 95358 <br /> CERES CAL000393680 I <br /> Faculty's Phone: 4 -3.S J <br /> ga 9b.U.S.DOT Description(including ProperShipping Name,Heard Class,ID Number, 10.containers 1f.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wl.Noi. <br /> a 1 NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OIL) 221 <br /> 001 TT G <br /> 2, <br /> u.t <br /> c� <br /> 3. <br /> 4. I <br /> 14,9pocisi Handling Instructions and Additional fin—farmotion <br /> EMERGENCY CONTACT:CHEMTREC 1-800.4249300 WOES TERMINAL:CERE * ATE PERSONAL PROTECTIVE <br /> EQUIPMENT*EMERGENCY CONTACT CHEMTREC 800 424 9300 *TRUCK# <br /> s <br /> 15, GENERATOR'S1OFFEROR'S CERTIPICATIOW I herebydeclare that the contents of this consfgnmeni are fully and accurately described above by the proper shipping name,aryl are dassrfA,packaged, <br /> marked and lobaledfplacarded,and are in all respects In proper condiffon for transport according to appi(ga�In International and national governmental regulations.If export shipment and i am the Primary <br /> Exporter,I cer*that*contents of this consignment conform to the terms of the attached EPAAcMd4iment of Consent <br /> I coAfy that the waste minimization statement Identified in 44 CFR 282.27(a)01 anj a large quanlitygenefeto'r)or(b)0(, m a email quar+tily generator)Is hue. <br /> GraI eslloffcror's Pf yped Name Sigq Month Day Year <br /> —r 16.International Shipments <br /> El tmportto U.S. ❑F,rport f Port of sntrylo>dl: <br /> Transporter signature(far exports only): Dale leaving U.S.: <br /> W 17 Tron5podwAcknowledgmentofReceiptofMatit0als <br /> ria Si gnlir Day au <br /> r Pin lkame 9 i <br /> Q <br /> Month Day Year <br /> Trarisportar 2 l'rlhtedCfypad Marne 9 ' <br /> 16.Disaepancy <br /> 18e.Discrepancy Indication Space ❑ Quantity ❑TyP- El Residue ❑Partial kajec;lon I—I Full Re)eeUon <br /> Manifest Reference Number. <br /> U.S.EPA ID Ndmber <br /> 1$b.Altemale Faeinty(or Generator) <br /> Fackitl(aPhoaot Mantic Day Year <br /> 10c.SlanAtureofAllemalugaullily(drGenemtor) <br /> 19.Hazardous Waste Report Management Method Codes Oe.,codes for hazardous waste Treatment,dlspasal,and recycling systems) <br /> : 2. <br /> 20,.t3o6t9nafed.Fcglty tamer or t 0minc Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a () <br /> Pool arae Slgna►ure Month Day. Year <br /> I_PA,Fogn 9700:22(124v.3 05) PTevlous editions are ohsoleie, DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />