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Please print or type. <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> �W;AeS�TSE MANIFEST CAL 0 0 0 4 0 7 0 3 0 1 800 424-9300 o-ewl� 0 2 0 0 618 31 JJ K <br /> 6. VnNI I EDamean��ailing Address Generator's Site Address(if different than mailing address) <br /> 4130 COVER STREET UNITED#5447 <br /> LONG BEACH CA 90808 1469 E HAMMER LN <br /> Generator's Phone: STOCKTON CA 95210 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> FREMOUW ENVIRONMENTAL SERVICES INC <br /> CAR 0 0 0 1 7 1 0 1 7 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> TEMARRY RECYCLING INC CAR 0 0 0 1 9 4 2 1 7 <br /> 8. e IGd�e� a rt e aif ttee ARRY DE MEXICO SA DE CV U.S.EPA ID Number <br /> CARR.FED NO.2 MEX-TIJ,KM 121 <br /> TECATE BC MA 21530 <br /> Facility's Phone: 415 662-9800 M X C 1 3 0 6 1 9 0 0 1 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> HM and Packing Group(if any)) 11.Total 12.Unit 13.Waste Codes <br /> 1 RQ UN1993,WASTE FLAMMABLE LIQUIDS, N.O.S.,(GASOLINE, No. Type Quantity wt.vol. <br /> o X WATER)3, PG III(D001) D001 D018 343 <br /> ST FLAMMABLE SOLIDS,ORGANIC,NOS0001 0015 352 <br /> X . . ., <br /> 2(GASOLINE,RAGS),4.1, II(DWI) ) <br /> iyo P <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional InformationPrOffle#Rfg�',24338—GesoNne$Water Prj <br /> ERG#128 2)R 19-24337-Flammable dS Primary Exporter T ry Temarry Recycling,Inc <br /> l X55 <br /> ��R�"g ERG#133 <br /> n 5 <br /> 15. GENERATOR'S/OFFER h y HANDLERS To BE 40HR TRAMW AND USE PPE.-ER Contract#205907 <br /> OR'SCERTIFICATION: Thereby declare that the contents of this consignment are fully and accurately described 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. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)orb if I am a small quantity O( q ty generator)is true. <br /> enerator's/Offer is Printed/Typed Nam gnature <br /> Month Day Year <br /> ``- ®1 <br /> j 16.Intemationa Shipments ZZE]Import to U.S. Export from U.S. Portof en xa: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> w <br /> Tran iter I Pr of a/Typed Name Signat J <br /> ti / '{�I� /T'�IG• Month Day Year <br /> Z I Transporter 2 Printed/Typed Nam Sig ture <br /> 1� j Month Day Year <br /> 18.Discrepancy 7 <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑ <br /> Full Rejection <br /> [Facility's <br /> :Alteemat:eFacility Manifest Reference Number: <br /> (or Generator) U.S.EPA ID Number <br /> w Signature of Alternate Facility(or Generator) <br /> ZMonth Day Year <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLI ��es�ignated <br /> --P0 ` 2. �l O 3 4 <br /> �Owneror Operator:Cerfification of rete pt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature <br /> ^�^ Mo Da Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. D IGN�TENACILITY TO EPA's e-MANIFEST SYSTEM <br />