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s • • <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) <br /> Farm provetl.OMS No.2050-0039 <br /> 7G,enemwes <br /> HAZkRODUS 1.General"IDNumbar 2.Pagaf of 3.Emargenq Response Phone 4.Mangest backing Number <br /> MANIFEST C A L 0 0 0 3 7 4 9 9 3 1 (800) 424-9300 �-4058209 0 JJK <br /> s Name and MsiFrtp Address Ge ar"'s ate Address tlfdHferenl Ihan meting address)RY MARY,E7` PLACE DBA SADI ENTERPRIV CmRTER WAY <br /> TON CA 95206 <br /> hone: 209 €532-8756 <br /> i Company Nama U.S.EPA:D Number <br /> ASBURY ENVIRONMENTAL SERVICES D 0 2 8 2 7 7 0 3 6 <br /> 7.Trponar 2 Company Name AI umber <br /> — ' <br /> 8.Des nnatad Fadlily Nama and SaDidlim, <br /> PACIFIC RESOURCE RECOVERYAPR O s to' U.S.EPAIDNumbers <br /> 3150 E. PICO BLVD. U <br /> LOS ANGELES CA 90023 <br /> Facky's Phprm; 800 499-7145 ,Wit-iUNME I&D 0 0 8 2 5 2 4 0 5 <br /> gn 5b.U.S.00T Descmmiion(including PraperShipping Name,Hazard class,t0 Number, _ <br /> and Packing Group M.bontainm ' IlAbtal 12,Unit <br /> HM g pP`any)j <br /> 1 No, Type Quantity YJWol. Waste Codes <br /> yTMl 9?C,e W&<"PV A'T.II?Atl1Ay'C�T TT.r CCYL'I.rij rirr yl7 P1ylT sa '9ti7 <br /> .....,._.. s...,.., ,.... <br /> N.O.S., (FUEL MSES AND ABSORBENT), 4.1, PG II D 14 16q p <br /> z 2. <br /> 3 <br /> 8I <br /> t <br /> i <br /> 14,s <br /> pawl HaraNing insWUions alio Aciammai lnforcna6on <br /> EMERGENCY CONTACT : CHEMTREC 1-800-424-9300 NAERG# 981 z 133 * PROFILE 8 9B1 <br /> 150302.12 FULL HOSES AND ABSORELNT * PO# A110205383 * APPROPRIATP L <br /> PROTECTIVE EQUIPMENT 9 � 1 <br /> i5 GENERATQR'SfOFFEROR'S Ctot <br /> ERTIFICAHUN: I hemay declare that to contents of end;consignment am fully and aOurzMy Macrined above by the proper shipping name,and am dasathid,Packaged, <br /> marked and labmedlplacwded,add are to all respects in proper condidon(".transport according to applicable international and national reg xpat shipment end l am the Prima <br /> govam�nfgl ulaiiuTs.If p ry <br /> Expader,I oerdly that 1`16 Oriehts of this Onsignmant Onfotm to Ise terms of the atlachad.EPAAdtirwMadgrrtdyri ofComsent. <br /> 7 Orgythat the waste minnization statement identhad in-00 CFR 262:2I(a)(f I am a large quantity generator)or{b){Ifl am a small quant raMp is true, <br /> Gemirato 01%'eroFePrimad?yped Nam, signature ,. Month Day Year <br /> 16,Imarnaterrml Shipments �. ff—'—�l <br /> Import to U.S. D Ezpon from LLS. Pon of ent ffi <br /> Aanspaner signature l`"swans nth : ry <br /> ... /) <br /> d' 1I:Tmttsporter AdinrMadgrceni of ReOtpt of Motorcars Date leaving US,: <br /> K Tra i PdnitiQRyped Nara <br /> Signature <br /> Manch Day Year <br /> Transxtme2 PnntadfTyped Name <br /> Big.....re M1hmth Day Year <br /> 19.Discrepancy <br /> Deciepancy 196Afion$pace -7 � � t —' <br /> C.J Quamly _Type l�I RResidueru Pariral Rejection ❑Fddl Rgacaen <br /> Manifest RelerenceNwmber. <br /> 16b.ANamahvFy(or Ganatatnr) U_S.EPA ID Numtier <br /> V <br /> Facgilys Phone. <br /> or Faulty{or Generaror} Month Day Year <br /> a <br /> 1 g.Hazardous YJaste Report Management li ettwd Codes(i.e.,Odes for hazardous waste ea eadem,disposal,and recycling systems) <br /> 20.Designated Facility @.mr.,ar Upeneeraecr.Cereacilm i Or local e(luueptaus materials covered by the mantlesl except as noted in Item 1a <br /> dMeo, vpsd Name S!gnaatra <br /> t Mo th Da Year <br /> arc kila <br /> EPA Forms?AO.22(.ev.3-0S Previous echoes are obsolete, DESK'S E.D FACILITY TO imsTINATION STATE (IF REQUIRED) <br />