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71 <br /> I ' l l .1 1 V 1. L J?1 <br /> Please pnnl or type. Farm designed for use on elite(12,pilch)typewritar.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Generelm ID Number 2.Page 1 of 3.Emergency Response Prone 4.Manifest Tracking Numbe <br /> WASTE MANIFEST C A L 0 0 0 2 9 3 3 6 3 1 (900)424-9300 014053185 JJ K <br /> 5.Generators Name and Mailing Address Generators Site Address(f different than ma7bg address) <br /> PRO LUBE INC #102 <br /> 808 S.CHEROKEE LN. <br /> LODI CA 91240 <br /> Generators Phone: 209 3332744 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Nam - U.S.EPA ID Number <br /> 6.Designated Facility Name and Site Address U.S.EPA ID Number <br /> EVOQUA WATER TECHNOLOGIES LLC <br /> 5375 SOUTH BOYLE AVENUE <br /> LOSANGELES CA 90058 CAD097030993 <br /> FacilivsPhone: (323)277-1500 <br /> 9a. 9b.U.S.DOT Description(including Pmper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> and Packin Gm d an 11.Total 12.Unit <br /> HM 9 up( Y)) No. Type Quantity WINol. 13.Waste Cod's <br /> 1' NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLIDS) <br /> 352 <br /> 0 <br /> L D V� P <br /> z 2. <br /> W <br /> 3. <br /> 4. <br /> 14,Special Handling instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 NAERG#981: 171 *PROFILE#981 :06 916.1 ABSOR ENT, RAGS, <br /> PAPER OIL FILTERS,OIL, DIRT, DEBRIS * *APPROPRIATE PERSONAL PROTECTIV EQUIPMEN /X � <br /> 15. GENERATOR'S/OFFEROR'6 CERTIFICATION: Iheraby declare Net the contents of this consignment are fully and accurately dasrzlbed abov by the pmper shipping name,and are 780-66d.padaged, <br /> manned and labeledlplawrded,and are In all respects in proper condition for transport eocording to applicable International and national governmental regulations.It export shipment anti I am the Pdmary <br /> Exporter,I cenify that the contents of this mnslgnment conform to the terms of the affichad EPAAdmowtedgment of Consent <br /> I coldly that the waste minimi ation statement Identified In 40 CFR 262.27(x)(If I am a large quanthy generator)or(b)(AI am a small quantity generator)Is true. <br /> Gen slORerors PHit Name Signa re Month Day Year <br /> /G <br /> J 16.lnte on hi mentis <br /> IL- Li Import to U.S. ❑Expan from 115. Port of entrylexit <br /> Transporter signature(for exports only): <br /> Date leaving U.S.: <br /> w 17.TransporterAdmowledgmanl of Receipt of Materials <br /> Transpo r 1 PrinsSignature Month Day Year <br /> O dR <br /> ' <br /> rensporter 2 Pdntetl/yyped Name m Month Day Year <br /> t16.Discrepancy <br /> 18a.Discrepancy indication Space ❑ Quantity ❑Type El Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> t6b.Alternate Facilgy(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> sa Faalilys Phone: <br /> w 16c Signature olAltemate Facility(or Generator) Monty Day Year <br /> 6 <br /> z <br /> W19.Hararduu Waste Report Management Meted Codes(i.e.,codes for hazardous waste treatment disposal.and recyd'i g systems) <br /> 3. 4. <br /> 1 <br /> 20..D aciiy Avner o OpeMlor.CeMIcabonolpceiptofha rdous matedels cove ed by the manifest exce as Med m Item laa <br /> P <br /> Sgnatv Mo Ye <br /> EPA Form 6700-22(Rev.3-05) Previous ediUons reobsolete. DESIGNATED FACILITY TO STINATIONSTATE (IFREQUIRED) <br /> 12398.1087 l"`�4z) 1z kk <br />