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-Aease Print or type. (Form designed for use on elite (12 -pitch writer.) <br />UNIFORM HAZARDOUS 1. Generator ID Number Z Page 1 of 3. Flnergency Response Phone <br />':PASTE MAktFES7 . C A D 028277036 1 (800) 424-9300 <br />5. Generators Name and Marl' Address Generator s Siie Addrrm rf nafa.e <br />AS8t1RY ENYI ONMENTAL SERVICES <br />1300 S. SANTA FE AVE <br />COMPTON CA <br />Generators Phone: 8009744495 <br />6. Transporter 1 Company Name <br />AS9IJRY ENVIRONMENTAL SERVICES <br />7 Transporter 2 Company Name <br />90221 <br />ZLWX NORTH AL.AMEDA STREET <br />COMPTON CA 90222 <br />Fadmy's Phone: (310)537-7100 <br />9a. 9b. U.S. DOT Description (ndrufing Proper Shipping Name, Hazard Class, ID Number, <br />HM and Parking Group (if any)) <br />a 1' NON-RCRA HAZARDOUS WASTE, LIQUID (OILY WATER) <br />w <br />Z <br />2. <br />w <br />c9 <br />Form <br />1� <br />mailing <br />OMB No. 2050-0039 <br />5 JJK <br />U.S. EPA ID Nrmber <br />CAD022277026 <br />U.S. EPA 10 Number <br />U.S. EPA ID Number <br />CAT080013352 <br />10, Containers <br />No. Type <br />11. Total <br />Quantity <br />12. Unit <br />W11W. <br />13. Waste Codes <br />D M <br />G <br />135, <br />1 <br />�r <br />®?I <br />S F I^' <br />I <br />F VIR r t <br />14.rc <br />.5pedal Handing Instructions and Pdditional Infomration <br />WRG#r 981 '.171 ` P RORLE 9 961 ° 370120 *EMERGENCY CONTACT= CHEMTREC 1-900-•12 9300 � <br />ADDITIONAL EPA CODES: 981:. Nqa0 OPRIATE PERSONAL PROTECTIVE EQUIPMENT <br />i <br />15. GEN ERATOWSrOFFEROR'S CER11FICATION: I hereby declare that tine cadents of this carrsigrttemd are fupy and accurately devaibed above � <br />marked and labs by a� shipping name, and are dans the Packaged, <br />ledlpbcarded, aril are in � respells it proper condition kx transport according b arpptkaWe ii�n>atiortal and national govemrrsental regr>fatknas. H export shipment and I am lie Primary <br />Exporter, I cartify that the contents of this wnsignfnent conform to the terms of the attached EPAAcknowledgment of Cornsent <br />I certify that tine waste minimlization statement Identified In 41) CFR 26227(a) (if I am a large W -W generator) or (b) rtf I am a sr ty gwwabr) is true. <br />4�� J_ <br />16. hdam wonai Shipments <br />❑ Import b U.S. ❑ Export Uom U.S. Pad of entr#exit <br />Transporter sign." (Jor eWwts o*)' Date leaving U.S.: <br />17.7rarrapor6fAclmov4edgrrrent of Receipt of klatariats <br />Tr xxte rmEedlTypho Name L Sign +e Month Day Year <br />fans 2 Rirnted(T Name <br />aG <br />Mor* Day Y <br />18. Discrepa q <br />18a. Dmaepancy Indication Space ❑ ❑ Type ❑ Residue <br />❑ PaU Rejection ❑Full RlJeclbn <br />18b. Alternate Fad °" aAOOa' <br />Aty (or Generator) <br />i U.S. EPA ID Number <br />Facility's Phone: , <br />9-- <br />E.. <br />ty (or Genereior) <br />Month Day Year <br />regement Method Codes (La., codes for hazardous waste treatrrnent. disposal, and recycling sysiems) <br />4. <br />Operator Ceftlflcatlon of us materials covered by the mantes( except as ncied n bd <br />Form 8 <br />22 (Rev. 3-05) Previous editions are o#�selete. DESi ATED FA ILI DESTINATION STAT (IF REQUIR D) <br />