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writer Form Approved. OMB No 2050-0039 GENERATOR UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number - C A L 0 0 0 3 9.8 1 1 3 2. Page 1 of 1 3. Emergency Response Phone (800) 424-9300.. 4. Manifest Tracking Number 014058.201 JJ K Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) IIT k-Ar ..AI.T.: .L": - Mi4;300 .11 8503 WINDMILL COVE RI) • ST ocKToN CA 95206 Generator's Phone: . 91i,5 289 -7797 Transporter 1 Company Name - U.S. EPA ID Number ASBURY. ENVIRONMENTAL SERVICES - ICADO 2 8 2 7 7 -0 -3 6 . _ Transporter 2 Company Name U.S. EPA ID Number I Designated Facility Name and Site Address U.S. EPA ID Number DDIENNO / KERDOON 2000 N. ALAMEDA STREET - . COMPTON , CA 90222 ' I CAT 0 8 0 0 1 3 3.5-2 .,. Facility's Phone: . ( 310) 537-7100 , ga, 9b. U:S DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. C,ontalners it. Toter 12. Unit 13. Waste Codes Him and Packing Group (if any)) No. Type Quantity YVtNol. 1. • • . NON -RC:RA ILASARLIOUS WASTE, LIQUID (OILY SLUDGE) 223.- '3 .DM 16-r ---G 2. • - 3. 4, 14. Special Handling Instructions and Additional Information . EMERGENCY CONTACT : CHEMTREC 1-800-424-9300 NAERG# 9B1 : 171 * .PROFILE # 9B1 032615-2 OILY SLUDGE POi A110205095 4, APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT 1 CSIC-5.75-6 'r 15 GENEFtATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are My and accurately described above by the proper shipping name, and are classifieo, packaged, marked and labelediplacarded, end 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 Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimtzation statement Identified In 40 CFR 262.27 a) (if I am a large quantity goner b) crf I am a small quantity generator) is true. Generator's/Offeror's PrintedfTyped C Name ` - . Signature 2:-•;----- Month Day Year / 1 I 0-3 61 ikl - International Shipments II Import to U.S. Export from U.S. Port of entry/exit Transporter signature (for exports only): , Dale leaving U.S.: TRANSPORTER Transporter Acknowledgment of Receipt of Materials Trans r 1 Printed/Typed Name . Signature Month Day Year .r e.-----/fh__ c...44. 1601:2[11T ..---- ransporter 2 Prin f yped Name * e Month Day Year i .111 DESIGNATED FACILITY 18, Discrepancy Discrepancy Indication Space UQuantity Type Residue Partial Rejection Full Rejection Manifest Reference Number. Alternate Facility (or Generator) U.S. EPA ID Number Facility's Phone, 1 Signature of Alternate Facility (or Generator) Month Day Year 1 1 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) , 1. 2. 3. 4. 20. Designated Facility Owner or Operator. 'Certification of receipt of hazardous materials covered by the manifest except as ncted in Item 16a Printed/Typed Name . Signature Month Day Year I I I I EPA Form 8700-22 (Rev 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)