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C' <br /> Please prInt or type.(Forth designee far use on elite(12-pitch)"Mitac) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Genmator ID Number 2.Pagel of 3.Emergency Response Phone 4ManNest Tracking Number <br /> rWTE,MANIFEST C A D 9 B 2 3 5 6 9 a 1 i CM) Q4-9300 n7`429761 JJ K '� <br /> 5.Geisralafs Jf a�Ii(�Add,'g5g, GoneratWs SheAddrees if different Thar Turing address) <br /> 1IPVVOCBBOOX 989 riUf{t\J 2373 WIPOSA ROAD <br /> LA PORTE TX 77572 STOCKTON CA 95206 <br /> Gsnerames Phare: 2109 464-7036 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ASBURY FNYlRONNENTAL 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 /> S.'%9WAWWWAOLOUIESCORP. U.S.EPA ID Number <br /> 6376 SOUTH BOYLE AVENUE <br /> LOS ANGELES CAC A D 0 9 7 0 3 0 9 9 3 <br /> FadWs Phone: <br /> (d?3)277-=277-16M _ — ._... _ ....-.._. <br /> ' <br /> ge, 9b.U.S.OOT Desalplon Qrdud%Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit t <br /> r3.Waato Codes <br /> HM and Packing Group(if any)) No. Type Ouandty Wt.Nol, <br /> 362 <br /> NON RCRA W17ARDOUS WASTE, SOLID (OILY SOLIDS) y �j (J <br /> D M rJ P Fff <br /> up 2 <br /> f7 <br /> 3. <br /> 4. r <br /> 4.Special Handling Instructions and Additional information <br /> NAER009B1 : 171'PROFILE#9B1 :AP 101169 OILY SOLIDS,ABSORBENT, SWEEPPO#Al 10127086'APPROPRIATE <br /> PERSONA.PROTECTIVE EQUIPNENT <br /> h225057 <br /> 15. GENERATOR'SfOFFEROR'SCERTIFICATION: I hereby declare that the contents ofthis consignment are hely and arwrately described above by the proper shaping name,and am deestrad,packaged, <br /> marked and labeledlplarearded,and are M all resperle In proper condition for transport scouduhg to applicable mtemat arraland na6orial govemmemal rogdatons,ff expert shipment and I am the Primary <br /> Exporter,I certify that the contents ofthm consignment conform to the tensa of the atradvi EPAAckmiWedgment of Consent <br /> codify that the waste minimizatlnn statement destine!N 40 CFR 252.27(a)Oil am a large quantity generator)or(b)(til am a small quentlry,generator,is We. <br /> here slOffehoes Pnnted? d Name Si Month Day Year <br /> 16.Intematone Shipments Import to U.S. /V} <br /> ❑Eapedh in U.S. Port of entry/exit <br /> Transporter slgwWn(fdre>gwris onyt: Date leaving U.S,; <br /> w 17.Trampler of Raceat ofMalerlals <br /> r. Trans 1 PrinanuTyped Name Slg.a!�n <br /> Yaar <br /> a <br /> Transporter 2 RlnsNTy me re Month Day Year <br /> 1S.Discrepancy l� <br /> elm.Discrepancy Indication Space ❑ Deal ❑ _ ❑Residue ❑Panel Reladbn ❑'Fun Rejection <br /> Manifest Reference Number. <br /> 18b.Atemate Fadlily,(or Generator) U.S.EPA ID Number <br /> 7 <br /> U <br /> w- FadRy9 Phone; <br /> a i&.Signature afAlternaate Fac ity(or Generator) Month My Year <br /> 2 <br /> 19.HamN as Report Managenant Method Codes 0.e.,codes for haamrdaue waste IreaMent,disposal,and mcyding systems) <br /> 4. <br /> 20.Designated F ifY afar .Certlbcatan ofrecelpt of ase -,, ered by the mantled except as riled In lfe 6a <br /> Pmtadrr)'pad Name shmalure Month ear <br /> EPAFonn B7o0-22(Rev.3-D ) Fri editions are obsolete, DESIGNATED kAdILITY TO DESMATION STATE(IF.REOUIRED) <br />