|
Please print or type. Form Approved.OMB No.2050-0039 -
<br /> UNIFORM HAZARDOUS I'-Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.M if tlctiM
<br /> WASTE MANIFEST GAC?0 2 8 21 7 0 3 8 1 (8Q�}4249300 � 6 4 J J K
<br /> 5.Generator's Name and Mailin Address Generator's Site Address(if different than mailing address)
<br /> WORLD.OiL EN IRONMENTAL SERVICES
<br /> 13W S.SANTA FE AVE
<br /> WMPTON 0Az2j,
<br /> Generator's Phone: 310 8864400
<br /> 6 Transporter 1 Company Name: U.S.EPA ID Number
<br /> : WYORLD,OIL ENVIRC)NMENTAL SF"C C A D t?2.8 17 0 3 8
<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 /> f BURY ENVIRONMENTAL SERVICE.CERES
<br /> IBM MORGAN Rn.
<br /> CERES CA 95355
<br /> ,.. .. CAL000398680
<br /> FacilitykPhone ..Z! 114U5 .
<br /> ga. .:9b..U:S.DOT Desedpfioni(ricluding.Proper Shipping Name,Hazard Class,ID Number, 10..Containers 11.Total 12.Unit
<br /> 13.Waste Codes'
<br /> HM .and Packing Group•(if any)) :.'. No. Type Quantity WtJVoI.
<br /> 0 I-NON NON RCRA I`iMFZDO WASTE.LIQUID(USEDOIL/Via!OIL)
<br /> .221
<br /> r- 001 TT 7 .
<br /> Z 2.
<br /> 3. 1 ..
<br /> 4•
<br /> 14:Spediai Handlinglnstrudtl6ris Arid Additional lhlbrmafiori"
<br /> EMERGENCY OWA",n GHEMTKC:1-80CJ 424- 1 WOE§TERMINALS-CERES *EMERGENCY CONTACT CHEMTREC
<br /> 430" fr APP'llOi'WTE PERSONAL PROTEMW IFMENT*NA RG 371
<br /> 1S i3tNERA1OR S10FFER0R S CERT)F[CATIOl3:'P &613y declare that tfie contents of this consignment are fully and.accgratcely,descnbed,above bythe proper shipping name,ard.are classified packed„_,., 1
<br /> marke 'atfidfabele lacarde 'tls
<br /> { r p, d,an re m a respects to proper condition for Transport according to appfica¢Ie mtemafionalandpafional goyemrnental;fegulattons.if export htpmenf and,l.am the Primary,
<br /> ES porter l cerhT'y that tlie'confdnts dthis ansignmeift conTrm to the terms of the attached EPAAcknowledgment of Conse t
<br /> f#cerci rm8}at tl�e waste mtnimiia�ibn sFateinerit'ideritif}ed'in d0 CFR 282:27 a tFFam'a'lar a uanti
<br /> O'( g q ty generator).or(ti)(}fi am:a smal(,quari6ty.generato�)ilrue..-.,.
<br /> Ge2eratoes/Offerors Printed/Typed Name - Sin
<br /> g ;rr Month
<br /> D+aey� ,YY�ear,.
<br /> t..16..Interr)atton<al Shipmentk,ir• t,; 4 °} ❑.
<br /> Z ,• ; ' ❑Impod to U S , .Export fro Port ofentry/exit.
<br /> Transporterstgnature(forekporls'only)` .....•..........::...: ... ...
<br /> 1 'TiansporterAcitowfe'dgment of Receipt of Mafenals
<br /> w
<br /> TOO
<br /> Traauporter 1-Prtntedffyped Name a;r:',. ` i , .. Signal i; ! Month Da Year
<br /> -Transporten2 P,rmted/Lyped;Name Si'
<br /> -vl�r:�-tz, �;l>s,t ! acr•:. ,t;, Month Day: Year
<br /> g18,DtsaepancY;.s,: 1•.R;? :y[. . .. :'
<br /> :18e 1)rseparicgancafion Space t!}=, ::
<br /> ❑ Qu`an6ry ❑Type Residue Partial Retectton ❑Ful Retechon:: ,
<br /> • r:,=:t„-.+n,:,':-:.::.::::..: ..._::,.;..,..::::,• .Manifest Reference Number...... -
<br /> 18b.11tematefaciuty:(or,Generator. :.,, U:S.EPA ID u ber
<br /> ) .N m,
<br /> LL
<br /> 18c St nature ofAifemate FacEh
<br /> g ty(or Generator). Month ' Da Year
<br /> a .:4.,.:} r, Y
<br /> 19 Hazartlo}is Waste Rtiport Management Meffiod Codes(t.e.;codes for hazardous`waste treatment,disposal,and recyclingsysterns)
<br /> 20.Designated Facility Owner or Operator,Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a
<br /> Printed/Typed Name Signature Month Day Year..
<br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY
<br />
|