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Please print or type.(Form designed for use on eli a(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM,NAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> .XASTE MANIFEST C A L 0 0 0 2 6 9 3 7 5 1 80W) 424-93CD 0 0 4 543709 JJ K <br /> 5.GenMit I Name and N PULL Mali Address Generators Site Address(if different than mailing address) <br /> 3827 CLARK DR, <br /> STOCKTON CA 962()6 <br /> Generators Phone: 208 -I(V7 <br /> 6,Transporter 1 Company Name U.S.EPA IO Number <br /> ASBURYENVIRONWENTAL SERVICES C A D 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 6.Designated Fadbty Name and Site Address U.S.EPA ID Number <br /> DE ENNO/KERDOON <br /> 2000 N.ALANEDA STREET <br /> COWP'TON CA 90222 <br /> Facifil IsPhone: (310)537-7100 C A T 0 8 0 0 1 3 3 5 2 <br /> be. 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, 10.Containers it.-Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packlrlg Group(Many)) No, Type Quantity WLNoI. <br /> 1. <br /> IX 223 <br /> F0NON-RCRA HAZARDOUS WASTE, LIQLAD DRAKE MA ) � D M G <br /> z 2. <br /> w <br /> THIS WASTE STREAM HAS BEEN QUALIFIED <br /> 3. <br /> DeMENNO/KERDOON FACILITY IN COMPTON, <br /> CALIFORNIA. THIS r,"I,MLITY HAS <br /> 4. :7'7E '` "JuR A';1ST[ STREAM A <br /> (NIAI-IFIED. OUR EPA NUMBER 1S CATOR00133F <br /> 14.Special Handling Instructions and Additional Information <br /> NAERQi get 7. <br /> 171 PROFILE 498t .298799 BRAKE FLUID'PO#AI 10085081 "APPROPRIATE PERSONAL PROTECTIVE <br /> EQU IPWENT <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby 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 Iabeledlplacanded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.It 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)or(b)(If I am a small quantity generator)is true. <br /> Generators/OMeeors Printedlfyped Name Signature Month Day Year <br /> rc 6" <br /> r <br /> J 16.International Shipments <br /> F ❑Import to U.S. ❑Expod from U.S. Port of entrylexit: <br /> = Transpodpr signature(for exports only): Date leaving U.S.: <br /> W 17.TransporterAcknoWedgmentof Receipt of Materials <br /> Transporter 1 PrinWffyped 7 Signature _- Month Day Year <br /> KTransporter 2 PdntWrr pe Name - Sig to th Day Year <br /> H <br /> 16.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial RejectionEl Full Reach., <br /> ectian <br /> __,-„�„ Manifest Reference Number: <br /> b. <br /> r iBAllemate Facility(of Generator) U.S.EPA 10 Number <br /> J <br /> U <br /> LL Facililys Phone: <br /> w 1 8c.Signature ofNtemate Facility(or Generator) Month Day Year <br /> zz <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> 20.Designated racility Owner w Operator:CeNfication of receipt of hammous materials covered by the manifest except as noted in Item 19a <br /> Print yped Name Signatu Month Day Year <br /> E AFo 6700- 2 Rev.3-05) Previous editiareobsolete. DESIGNATED FACILITY TO GENERATOR <br />