Laserfiche WebLink
21� <br /> Please printtype-{form designed for use on elite(12-pitch)typewriter.} Farm Approved.MOM.2050-0035' <br /> UNIFORM HAZARDOUS # Generator Id Number 2.Page 1 or 3.Emergency Response Phone 4.ManifestTracking Number i - <br /> WASTE MANIFEST CAL 0 0 0 3 3 0 4 2 3 1 800 424-9300 01_8 17034 8 J.J K <br /> 5.Generakft Narste and MailingAddress GeneratoftSRO Address(if different than mailing address) <br /> Q AND M,DBA TRACY CHEVROLET-QANO0i1 <br /> 3400 AUTO PLAZA WAY <br /> TRACY CA 95304 <br /> Generator's Phone: , 289 8354500 . <br /> 6.Transporter 1 Company Name - U.S.EPA ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICES C A D 0 2 8 2 7 7 0 3.6 <br /> 1.Tfansporter 2 Compady Name U.S.EPA ID Number <br /> 8.D"anated Facifly-?a"andSiteAddress U.S.ERUD-Number <br /> WORLD OIL RECYCWNG - <br /> 2008 N.ALAMEDA STREET <br /> COMPTON CA 90222 CA TO 8001335.2 <br /> Fncf W" Phone: <br /> 9a. Sh,U.S.DOT Descripllvn(incfud rig Proper Shipphrg Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and PacBing Group[d any)) Na. Type tluardity WLW <br /> a RQ:UN1993,WASTE FLAMMABLE LIQUID,N.Q.S.,{GASOLINE, pool J2"&20 <br /> DIESEL}.3,PG I! <br /> x <br /> cp - <br /> .4. - <br /> -14.Mat Handling lnstructmns and AddMonahlefGmia�an <br /> EMERGENGY CONTACT:CHEMTREC 1-800.424-9300 WOES TERMINAL.CERES CS NAERG##981 328*PROFILE#9B1: <br /> 421485 GASOLINE.DIESEL* *APPROPRIATE PPE-EQUIPMENT ��f <br /> 1S GENERATORS[OFFERORr$,C-MIFMATIOH:I hereby declare thetthe oanlenksof his cun�,Igriraeiiiam fullyand accuratefydesrAbed above 1*theprapershippIng name,and-ire:Elassl d,:"�78i god; <br /> markedand IaSeiedfplacarded,and.8rgln till respects is prapercondr4on fortrarort accar�iiig.ty applica6faintemativnaland nativnat.govammental regulaffons.ifexpartsh1pn7ent asid f amitje-Rn 'ar <br /> Exporte,I certify WE the eai nLs p[tfi`9 carislpr ikt conform to the temps of the attached EPhAdaiowl@di"orConger <br /> I cerS(y tha!!he wasfemiia�pn stalemeritldsntifiddln 4G.CFR 262Z7{g}{�f3 amaParge cyu._.. gerlerafor}or{h}���n;a a quantiiygenerato�Is ire. - <br /> e eraWPslrur�Pr <br /> jp :Name"' Sign <br /> ahrrey . <br /> 16:1nIiam1tlonal SNpmeota <br /> i; Olmpartta U.$: ❑.Ex{wrtfinm EIS, Portaren6ylopt: <br /> � Transporterslgnalore{farexpnrtsonly); Dateleaufn�}l.s.: <br /> LU 17.Trans Ls AclonvwledgmanEnf ReWai of lNa eiial <br /> T 1 Pr ntedlI]rped Name 53gnarure. _ Muth U�Y 'tesi <br /> '��•'.T1. <br /> mnspoJtar2.Printedf€ypedName L Signature <br /> Mouth aq•: '1411 <br /> #8.Discrepancy <br /> 18a.Discrepancy Ind an Space 00 ❑Typq ❑Resldue 0:130W Rejection ❑ +11lejs y6on;" <br /> Manifest Reference.Nurrnhr: <br /> 18b.AltemMe Fadlity(or Generator) U.S.E AUNiirisUer r <br /> U <br /> tQr. Faal s Phone: <br /> 18c.Signature of Alternate Faality{or Generator) rtltn Day Year' <br /> a <br /> 2 <br /> 19•Hazardous Waste Report Management Method Codes(.e.,codes far hazardous vrasie Geatment disposal,andrecyca ng systems} <br /> C1. 2. 3. 4. <br /> • 5. <br /> Zit Designated Fadlity Owner or Operator.Catlficatlon of reseipt-of hazardous matedals covered by are mardestexcept as noted in.bm 18a <br /> Pnn[edfTyped Name Signature Month Year <br /> ,EPA Form 87W 22[Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO:DESTINATION STATE{IF REQUIREI � <br />