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3400 Auto Plaza Way. Record ID# PR0514278 <br /> 11/3/2020 Program: HW <br /> Photo 22: The following uniform hazardous waste manifest (020380611JJK) observed lacking signed copy. <br /> t1 Please pont or type_ Fane Approved-OMa No 205x0039 <br /> ir I UHIFORN HAZARDOUS 1.Owerahr tU Number 2 Page 1 of 3 Em nilncy Response Pholie a.Maddrei lne.ng Hlos,),w } <br /> WASTE MANIFEST CAL000330423 1 (aW)424-9300 0203$0611 JJK <br /> l_.FI s cenerawrs Na and M a�n Aad <br /> 0 3400 AUTO PLATAWAYHVV�LEF QAN001 Denarata,sn,Adams,brmmlpmmea maa�rg aaamssi -- <br /> TRACY CA 95304 - <br /> F Gmaralor,Phrna 2098364600 <br /> 5 s rmspoderl Carmanv Name <br /> WORLD L ENVIRONMENTAL 9ER410E8 u s C Aro Nu 2 <br /> CAD028277038 'ER <br /> 7 Transporter 2 Company Name <br /> ^� us sante Nnmp,r <br /> I aDeagnamd P-,Nempantl Srle AEdresa US EFAIDN-1i <br /> p WORLD OIL RECYCLING <br /> --- G�OM�PT5" CA AMEDA <br /> 90222 CATO BO013352 <br /> r q Facis'a phone. 31Q ----- _ — a-U11, <br /> P. 9b.U 5 DOT Deacnggn pnnodirg Proper Shipping Name,Haaard Class,lO Number, In.C r ainele 11 Tye! 12 Unit�- HM arM Paµing Group(e anY11 13 Wsate Codes <br /> Np. TY, Ouanptq WLNoI -�- <br /> I.RQ.UN1993.WASTE PLAMMAALE LIQUID,N.0.9..(GASOLINE. D001 [X138 343 <br /> y_ DIESEL).3.PG 11 - <br /> ` 1' 3 DM 35, O <br /> w z <br /> r <br /> f <br /> 14 Speriel Heni Instmgiona and AddrGonal InluTnation <br /> EMERGENCY CONTACT:CHEMTREC 1.800-424-9900 WOES TERMINAL:CERES CS NAERGN 4B1 128 PROFl1E M 981 <br /> 422485 GASOLINE.DIESEL• 'APPROPRIATE PPE EQUIPMENT#eZU I ♦� 5 5 <br /> 15 OENERATOR'SIOFFEROR'$CERTIFICATION:Ina dy dedare that ma pendants of Nis consignment are oily asd ie pUrataly descnbedd,he by the proper Shipping name.and ene pag5�jsp pace d <br /> marked and IaUeledl".1ded,and arein all reepects'rn proper condition for tranalwd according to applicable inlemaeonal aabona <br /> EwAter Iwrbly that Ne COntenta of this consgnmedt coniorm to the terms of Na attached EPAACFnow1 rgo�m mguleoons.11 e,po"5ll'g_1 amt am he <br /> Primary "_ <br /> I nerhy that the waste minimization statameN idenUhee In 40 CFR 262.27 a if I e a a N naenl. <br /> O( rgequantl ralor)or(b)(ill am a smaA quash tar)u hue. <br /> Generamty0rf Narrle Signature <br /> J <br /> Np <br /> }6.Mardi Ship-15 <br /> rl�f 7 I 0 a Yt�l <br /> 'GNS <br /> ❑Import 19 U.S. ❑Diednfrom Port ofentryiSxit <br /> M Transporter signai[for ex ports anfyf. <br /> GO 17.T,aaspolta A&mwledgmentuf Re iptolm.OUs bale 1—ng U.S.: <br /> w <br /> � Transporter i rtntedlTy <br /> I p1ed Name <br /> a �UNV) Signature jj/ Oxy Year <br /> Tradispoder 2 Prmledlryped Name I /0)`+ !1 <br /> r SlgnaMre Monty pay Year <br /> t8.plsaepanty <br /> __ � ides Discrepancy Indiwhon Space <br /> ❑OuaaWY ❑Type ❑Rasitlue ❑Partial Rejeclwn ❑Full Relectrdn <br /> it 1$b,Altemate Fadgty(or GeneraldR Idanilest Relarenca Numbec _ <br /> U.S.EPA1 Numhar ----- --- <br /> U <br /> LL Faci9ty'a Ptrone: <br /> w 1&.Signatureal Altemele Facitily for Generates) <br /> z Mdnln Day 4ear <br /> 19.Hazardous Waste RepOM1 Management Method Codes f1 e„codes for hazardous waste Iraatmenl,disposal,and recycling systems) <br /> W 7 <br /> O 2, 1 9 <br /> 1 20 Designated Facility Owneror Operator:CertiAwtlon of receipt of hazardous materials covered by the manliest eecept as nded in Ism Ida <br /> %ntednyped Name <br /> Signature ManN pay Year <br /> EPA Farm 8708.22(Rev.12-17(Previous editions are Dhsolete, <br /> " GENERATOR'S INITIAL—COPY <br /> JASON GAITAN, REHS Page 22 of 48 <br />