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Please print or type.(Form designed for use on elite(12-pltch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2,Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Numbor <br /> WASTE MAN C A R 0 0 016 0 0 6 9 1 (800)4249300 015141035 JJ K <br /> 5.Generator's Name and MallinAddress Generators Site Address(If ddrerent than mailing address) <br /> TRACY MAZDA- 121 <br /> 2680 AUTO PLAZA WAY <br /> TRACY CA 95304 <br /> Generators Phone: 209 820.7800 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> RSBURY EIJVIRONMENTAL SERVICES CAD 02.8 2 7 7 0 3 6 <br /> 7.Transporter2 Company Name U.S.EPA ID Number <br /> 8.Designated Fad ly,Name and Site Address U.S.EPA ID Number <br /> EVOQUA WATER TECHNOLOGIES LLC <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 CAD 0 9 7 0 3 0 9 9 3 <br /> Facility's Phone: (323)277-1500 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12 Unit <br /> HM and Packing Group(If any)) 13.Waste Codes <br /> No. Type Quantity WWoI. <br /> c 1.NON-RCRA HAZARDOUS WASTE SOLID,(BRAKE LATHE SHAVINGS) 181 <br /> 0 <br /> / <br /> 0M �O P --- - <br /> z 2. <br /> LU <br /> 3. <br /> 4. — — - <br /> J. <br /> �. <br /> 14.Special HandliM Instructions and Additional Irdormalion <br /> EMERGENCY CONTACT:CHEMTREC 1-800424-9300 NAERG#981:171*PROFILE#961:AP199000 BRAKE LATHE <br /> SHAVINGS*PO#A A110221879*APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT r <br /> ,�2 <br /> 15. GENERATOR'S10FFEROWS CEFMRCATION:1 hereby declare that the contents of this consignment are fusty and accurately described above by the proper skipping name,and are dassffled,packaged, <br /> Marked and tabeledlplararded,and are in all respects in proper condition for transport according to applipble I nten naland national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I'certify that the contents of this toms gnment conform to the terms of the attached EPAAcImMedgmenl of rtL <br /> I certify that the waste minimization statement identified In 40 CFR 26227(a)of I am a large quantity genemml r)or (fl am a small quantity rator)is true. <br /> Generator rsrinte Signa Month Day Year <br /> W-� 7)�L /t"� �/ 1/-7- 1/r I/--) <br /> -1 16.International Shipments <br /> F Elimport to U.S. ElExport from U.S. Port of entry/ez t <br /> Z Transporter signature(for exports only): Date leaving U.S_ <br /> w17.Transpoder Ackn wledgment of Receipt of Materials <br /> T anspon P inted/Typed Name Signature ��' Month Day Year <br /> Z Transporter Printed/Typed Name STata9 Month Day Year <br /> I <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity Type ❑Residue QPartlal Rejection ❑Full Rejection <br /> Mawfest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> Li Facility's Phone: <br /> LO 18c.Signature of Aftemate Facility(or Generator) Month Day Year <br /> z <br /> 19.Hazardous Waste Report Management Method Codes Q.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. / 2 T- <br /> 20. <br /> Designated Facility Ow'or Operator.Certlficatlon of re tpt of hszprdouymaterFals covered by the manifest except as nded in Item JBa i <br /> Prmted/Typed Name ! r Sg>afure r Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous edl4ons are obsolete. DESIGNATED A' LITYTO DESTI ATiON STATE(IF REQUIRED) <br />