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,s print or type:(Form designed for use oneIits(12-pitch)typewriter.) n Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1:Generator ID Number 9" 2.Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number <br /> WASTE MANIFEST CAD 0 2 9 5 0 3 7 0 3 1 (800)424-930J. 1 017695382 J J K <br /> 5.Generator's Name and Mailing Address Generators Site Address(It dinalent than mailing address) <br /> STANLEY ELECTRIC MOTOR COMPANY-ST:A128 <br /> 1320 E MINPRAVE <br /> STOC'..(TON CA 95205 <br /> Generator's Phone: 209 464-7321 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> WORLD CIL ENVIRONMENTAL SERVICES C AD 0 2 8 2 7 7 0 3 6 <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 0!L RECYCLING <br /> 2000 N.ALAMEDA STREET <br /> COMPTON CA 90222 <br /> Facility's Phone: (3g_ r -71 O l,.'A T Cl 8�}Q 13 6 "� <br /> 98, 9b.U.S..OCT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.NoL <br /> W NON-RCRA HAZARDOUS WASTE, LIQUID(MACHINE COOLANT) <br /> ) <br /> F ! 1t? <br /> 0 THIS WASTE STREAM HAS BEEN OIJALIFIED <br /> i ' FOR RECYCLING./1REATMENT Al THE --" <br /> DPMENN0/I<ERDOON DBA WORLD Oil j R <br /> 3. Rl FPC LI Y IN CC iF"O'l,CALIFORNIA. <br /> THIS F t.JTYha TH-IHF SFnY PEHi11TS TO 6 f! <br /> RE ' iVE YO!.,"4dASFE SIFT IA,1 i0'ALIFED. <br /> OUR FIDA\r:, ,I Karo <br /> 4 <br /> ,.- •.-,. 7o- ' . ..>.. �� I_._,_.„T. <br /> 14.Special Handling Instructions and Additional Information 11 <br /> EMERGENCY CONTACT:CHEMTREC 1-800.424.9300 WOES TERMINAL: CERES CS NAERG#981:171 *PROFILE Af 961 : <br /> 10920-STA128 MACHINE COOLANT * *APPROPRIATE PPE EQUIPMENT <br /> 1 1,,91, 0 (�o I X � ,) .4 <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately descrlbed 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 EPA Acknowledgment of Consent. ,a <br /> I certlfy that the waste minimization statement identified In 40 CFR 262.27(a)(It I am a large quantity generator)or,(b)(If am aasm II quantity generator)is true, <br /> Generato�jr)�s/(9Offe profs Printed/Typed Name / Signature I M(/�o�}nth Day 'Year <br /> 16.Intonational Shipments <br /> f-- ❑Import to U.S. ❑Export from U.S.. Pod of entrylexit <br /> Z Transporter signature(for exports only): Dale leaving U.S.: <br /> ILL] 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter i PrintedlTyped Name Signature Month - Day Year <br /> N I 1i7 <br /> Transporter 2 PrinledlTyped Name Signature z Month Day Year <br /> h <br /> 18.Discrepancy <br /> 1 So,Discrepancy Indication Space ❑ quantity ❑Type ❑Residue 1 ❑Full Rejection <br /> YP ❑Partial Reaction <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) - U.S.EPA ID Number <br /> J <br /> U <br /> LL Faculty's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> 6 <br /> Z <br /> a—i 19.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2. <br /> 20.Deslgnated Facility Owner or Operator Cedlfication of recelptof hazardous materials covered by the manifest except as noted In I1018a r/ <br /> PrntedlTyped Name 7 I Signature -7- y Month Day Year- <br /> f / <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. ( 4 - /-®ESIGNATED FACILITY TO GENERATOR <br />