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`i <br /> IBM <br /> Please print or type. (Form designed for use on elite (12 itch) typewriter.) Form Approved, OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page 1 of 3, Emergency Response Phone 4. Manifest TrackNumber <br /> WASTE MANIFEST CAL 0 0 0 3 8 5 0 0 3 1 (800) 424a 017191344, <br /> 00001 <br /> S. Generators Name and Mallin Address Generatots Site Address (If different than mailing address) <br /> PREMIER CHRYWLER DODGE JEEP RAM OF TRACY - PRE14 i <br /> 3460 NAGLEE ROAD <br /> TRACY CA 95304 ' <br /> Generators Phone: 209 8204815 <br /> S. Transporter 1 Company Name U.S. EPA ID Number <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7, Trensporter 2 Company Name U.S. EPA ID Number <br /> 68, Desinoted Facility Name and Site Address U.S. EPA ID Number <br /> 6EMENNO / KERDOON <br /> 2000 N . ALAMEDA STREET <br /> COMPTON CA 90222 CAT 80013352 <br /> Fad!! s Phone. (310 537-7100 - • <br /> go. 9b, U.S, DOT Description (including Proper Shipping Name, Hazard Gass, ID Number, 106 Containers 11. Tota) 12. Unit 13. Waste Codes <br /> HM and Pecking Group (d any)) No. Type duant!ty WNJoI. <br /> 1 UN1993, WASTE FLAMMABLE LIQUID, N .O.S. , (GASOLINE. DIESEL; I � D001 D018 343 <br /> Fro WATER), 3, PG II <br /> DM 5G <br /> _ . .. -- - - .._ . . . . . - . - . _ . -. . . . . . _ <br /> z 2, <br /> W <br /> t9 <br /> 3. <br /> 4, <br /> 14, Special Handng Instructions and Additional information <br /> EMERGENCY CONTACT : CHEMTREC 1-800 424-9300 WOES TERMINAL: CERES CS * PROFILE # 961 : 042717-01 GASOLINE, <br /> DIESEL, WATER * * APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT Z <br /> 15. GENERATOWSIOFFEROWS CERTIFICATION: I hereby declare that the contents of this consignment are Idly and accurately described above by the proper shipping name, and are classified, packaged, <br /> marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable Intemalionaland national governments! regulations. If export shipment and 1 am the Primary <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowiedgmenta nsent. <br /> I certify that the waste minimization statement Identified In 40 CFR 262.27(a) (if I am a large quantity lie_ tor) or dl am a small quantity generator) is true, . . <br /> Gen , slO0 rs Pdnledfrl ame Igna it Mon it ay Y par <br /> JL �` <br /> ode <br /> 16. <br /> ❑In motional Shipments Import to U.S. ❑ Export•from U.S. Port of entry/exit: <br /> z Transporter signature (for exports only): Date leaving U.S.: <br /> a 17. TransporterAdknowledgment of Receipt of Materials <br /> Transporter 1 Pdnted/Typed Name . L'( �ry ignature � Mon ay <br /> Z <br /> Transporter 2 Frid/ly <br /> nteped Name Signature Month pay Year <br /> 18, Discrepancy <br /> 18a, Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> 16b, Alternate Facility (or Generator) U.S. EPA ID Number <br /> 3 <br /> v <br /> tea. Facill y+s Phone: - Month Day Year <br /> W 18c. Signature ofAltemate Fecility (or Generator) <br /> Q <br /> Z <br /> N19. Hazardous Waste Report Management Method as (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> G 1 2 3. 4. <br /> 20. • esignated Fa 'lity Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedilyped Name Signature Month Day Year <br /> aZ : <br /> EPA Form 8700.22 (Rev. 3.05) Previous editions are obsolete, DESIGNATED F TY TO DESTINATION STATE (IF REQUIRED) <br />