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ti <br /> y. -Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone _r0 <br /> .Manifest Tracking Number <br /> WASTE MANIFEST C 00 180 1 888-785-7225 014 7 0 5 9 41 F L E <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Aisin Electronics Inc <br /> 199 Frank West <br /> Stockton, CA g52 <br /> Generator's Phone: 7n n4i <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Advanced Chemical Transport Inc./DBA ACTenviro CAR00007OW <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> World Oil Recycling CATOBOO13352 <br /> 2000 N Alameda St <br /> Compton, CA 90222 <br /> Facility's Phone: 31 537-7100 <br /> ga 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 Packing Group(if any)) No. Type Quantity Wl.Nol. <br /> 1Non-RCRA Hazardous Waste Liquid(Oil) DM �� p 221 <br /> 0 <br /> w <br /> Z <br /> w <br /> 0 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information project Number 248190 Document#: D298486 <br /> 1) AIW- -> S-5 <br /> 15. GENERATOR'S/OFFEROR'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 labeled/placarded,and are 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 certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consnt. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small qu ntity generator)is true. <br /> rator's/Offeror'sPri ted/Typed Name Xture MorlJh Day Year <br /> J 16.International Shipments <br /> F ' ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Z—I Transporter signature(far exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LU 1Transportdffryped Name Signature Month Day Year <br /> IL er 1 rintef& I <br /> z Transporter 2 PrintedlTyped Name Signatu Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Typej j <br /> ❑Residue Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> 0 <br /> LL Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> CO 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> � 1 p 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 141 <br /> Printedfiyped Name 1I0 <br /> 4 , 1 Signature WVDay Year <br /> em7l` <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />