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Please print or type, Form Approved, OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1 . Generator 10 Number 2. P=3Emerge.ncylResponse Phhone 4. Manifest Tracking Number <br /> WASTE MANIFEST CAL000336676 24-9300 023555393 JJ K <br /> 5. Generator's Name and Mallin Address ' Generalors Site Address (if different than mailing address) <br /> STORER TRANS, <br /> - ST0051 <br /> S519 MC DONALD AVE <br /> MODESTO CA 95358.9 7 70 1909 S ARGONAUT STREET <br /> Generator's Phone: 209 6445114 STOCKTON CA 95206 <br /> 6. TranspWORLDOIE ENVIRONMENTAL SERVICES u s CAD 0 2PA 1D r8 2 7 7 0 3 6 <br /> 7. Transporter 2 Company Name U.S. EPA 1D Number <br /> 6. Designated Facility Name and Site Address U.S. EPA ID Number <br /> WORLD OIL RECYCLING <br /> 2000 N . ALAMEDA STREET <br /> COMPTON CA 90222 CAT 0 8 0 013 3 5 2 <br /> Facility's Phone: (310)537-7100 <br /> ga. 0b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, iD Number, 10. Containers 11 . Tolai V. Unit 13. Waste Codes <br /> HM and Packing Group (d any)) No. Type Quantity WLNol, <br /> 1 . RQ, UN1993, WASTE FLAMMABLE LIQUID, N .O.S „ (GASOLINE , D001 DOLS 343 <br /> n DIESEL) , 3, PGI / <br /> DM 1 570 <br /> G <br /> L 2 <br /> LU <br /> 3. <br /> 4. <br /> 14. Special Handling Instructions andAddillonal Information <br /> EivIERGENCY CONTACT : CHEMTREC 1.-800.424-9300 WOES TERMINAL: CERES CS NAERG# 9131 : 128 * PROFILE # 01 : <br /> 474450 GASOLINE, DIESEL * * APPROPRIATE PPE EQUIPMENT %, x55S <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are hilly and accurately described above by the proper shipping name, and aredassified, packaged, <br /> marked and iabeled/placarded, and are In all respects in proper condition for transport according to applicable intemationaland national governmental regulations. If export shipment and t am the Primary <br /> Exporter, I ceriily that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a) (f i am a large quantity generator) or (b) ( I am a small quantity generator) is true, <br /> GeneratornMA <br /> d/Typ,e0� Name Signature Month Day Year <br /> � A /"TG�er+� XIZ Izz. I Z \ <br /> a <br /> 16, Intemational Shipments <br /> ❑ Import to U'S. ❑ Export from U.S. Port of entrylexit, <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> iX LU <br /> 17, Transporter Acknowledgment of Receipt of Materials <br /> L2 Transporter 1 Printed(Typed Name Signature Month Day Year <br /> Transporter 2 PrintedtTyped Name Signature Month Day Year <br /> r <br /> 16, Discrepancy <br /> 18a. Discrepancy Indication Space Quantity ❑ Type El Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> 16b, Alternate Facility (or Generator) U,S, EPA ID Number <br /> a <br /> v <br /> Facility's Phone: <br /> 18c. Signature ofAltemate Facility (or Generator) Month Day Year <br /> 4 <br /> z <br /> U) 19. Hazardous Waste Report Management Method Codes (,e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 0 1, <br /> 12v J14 <br /> 4. <br /> 20, Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a <br /> Printedfryped Name Signature Montt Day Year <br /> rlti ® � r te .S a <br /> EPA Form 6700.22 (Rev, 12-17) Previous editions are obsolete. * DESIGNATE FACILITY TO EPArs e•MANII=EST SYSTEM <br />