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r � <br /> Please print or type. (Form designed for use on elite (12-pitch) typewrites) r Fotm Approved. OMB No, 20SH039 <br /> UNIFORM HAZARDOUS t ' Ge"GAL Number <br /> 0 er 3 8 5 0 0 3 12o Pal 1 of 3. Em eig pc�)4 p2° 3Pt a 4. Manifest Tracking Number <br /> WASTE MANIFEST ((��00 016869603 JJ K <br /> 6' Gone VMM "M'K2R DODGE JEEP RAM OF TRACY - PRE14 i Generator's Site Address (d different than ma8ing address) <br /> 3460 NAGLEE ROAD <br /> TRACY CA 95304 <br /> Generators Phone: 209 8204815 <br /> 6. TransporZe ,OMMONMENTAL SERVICES U.S. EPClatVt2 8277036 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 6. Design att� IVI9NN aAft r� U.S. EPA ID Number <br /> 201OVtOtINV.IVALAMKEttD�A STREET <br /> COMPTON CA 90222 CAT080013352 <br /> Facilites Phone: (310)537-7100 <br /> 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit 13. Waste Codes <br /> HM and Paddng Group (If any)) No. Type Quantity Wit/void <br /> 1. UN1993, WASTE FLAMMABLE LIQUID, N . O.S. , (GASOLINE, DIESEL, D001 DOIS 343 <br /> Ix WATER), 3, PG II 1 D N G <br /> 1{ <br /> z 2. <br /> w <br /> c� <br /> 3. <br /> 4. <br /> 14. Spatial Handling Instructions and Additional Information <br /> EMERGENCY CONTACT : CHEMTREC 1-800424-9300 * PROFILE # 9131 : 042717-01 GASOLINE, DIESEL, WATER <br /> APPROPRIATE, PERSONAL PROTECTIVE EQUIPMENT Ememb #�-21 , / x 5� <br /> 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, <br /> marked and labeledtpiacarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipinent and I em the Primary <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify Uiat the waste minimization statement Identified In 40 CFR 262.27(a) (if I am a large quantity generator),pP(bK1jmV small quantity generator) is hue. <br /> Ge rat erors rinted/Typed Na igna Month Day Year <br /> � J•C� tb <br /> —+ <br /> 16, Intemabonal Shipmen <br /> ) — ❑ Import to U.S. ❑ Expon from U.S. Port of eniryfexit <br /> z Transporter signature (for exports only: Date i ving U.S.: <br /> W 17. TransporterAcknowiedgment of Receipt of Materials <br /> Tran iter 1 PdntedrFypqd Namel Signature , Month Day Year <br /> a �� AA P051 k) 74 <br /> Z Trarill9fter 2 Pfinted/Typed N me Signature Month Day Year <br /> 18, Discrepancy <br /> •18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection ' <br /> Manifest Reference Number. <br /> 18b, Alternate Facility (or Generator) U.S. EPA ID Number <br /> V <br /> W Faclliys Phone: <br /> W 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> Q <br /> z <br /> N19. Hazardous Waste Report Management Method Codes p.e., codes for hazardous waste treatment disposal, and recycling systems) <br /> wo 1 . 2. 3. 4. <br /> 20. Designated Facrlity Owner or Operator. Certification of receipt of hazardous materials covered by the manifest exgphpixto In Item 18a <br /> MWEEMENEEN <br /> Printed/r Nam t J / ?, Srgnatu M41h Day Year <br /> EPA Form 8700.22 (Rev. 3,05) Previouse itionsareobsolete. DESIG FACILITY TO DESTINATION STATE (IF REQUIRED) <br />