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''*6 Please$int or type.µ Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number:. 2 Page I 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST C A L 0 O O 3'7 0 3 96 (800)424.9300020180691 J J K ! 5.Generator's Name and Mailin Address 'Generator's Site Address(if different than mailing address) ; FIRESTONE 4 306.2 040 N,CENTRAL AVE TRACY CA ., 951376 Generator's Phone: 209??14*4 6.Transporter 1 Company Name: - U.S EPA ID Number WORLD OIL ENVIRONMENTAL SERVICES '02A 271O 6 7,Transporter 2 Company Name U.S.EPA ID Number 8.Desi nated Facilit Name and Site Address U.S.EPA ID Number 0�3LO IL RECYCLING 2000 N,ALIkMEDASTREET CO iPYO[ 92 C k TOJ Facility's Phone ( 0) 37.7100' 9a, 9b U S DOT De:; ripkori(including Proper Shipping Name;Hazard Class,ID Number; 10.Containers X1,1 Total 12 Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity <'' Wbvol.` ' 1-NON-RCRA HAZARDOUS WASTE,LIQUID 4 OILY, TER) D M €� 1 z 2.' L„ i) 3. i ,r 4. 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT:CHE TREC I^ 424-900 WOES-'TERM NAL:CERES CS NAERGO 9BI:171 PROFIL #981, 05212W.9-01 OILY WATER *APPROPRIATE,PPE EQUIPMENT � e� e�^ s 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,, 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 I I Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 26217,(a)(if I am a large quantity generator)or(b)(ifl qm a small quantity generator)is true. j Generators 0(feror's Printed[Typed Name j Signature M tt'hh Day Year k _ &F Pl .j 116.International Shipme s j_ ❑Import to U.S. ❑Export from U.SCw,_w^" Port ofentry/exit ^` Z Transporter signature(for exports only): Date leaving U.S.: W17.Transporter Acknowledgment of Receipt of Materials a r- Transporter 1 Printed/Typed Name j41, � Signature r^' Month Day Year i KL 41 z Transporter 2 Printed/Typed Name Signature Month Day' Year I i 18.Discrepancy j 18a.Discrepancy Indication Space ❑`Quantity ❑Type:: ❑Residue ❑Partial Rejection 1 �; ❑Full Re'ection r Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number f J 't rai Facility's Phone: w 18c.,Signature of Alternate Facility(or Generator) Month Day Year z S2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1 4. 11 20:Designated FacilityOwner or Operator:Certification of receipt of hazardous materials covered by the manifest except as ncted in,Item 18a Printed/T gd Name Signature M nth Day Year , EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. TANSP®RTR COPY 1 : l