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cesi0r.nd for use on elite(12-piton)tyoelmler.) FormAaprovad.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.GeneralorlD Numner 2,Page 1 of 3•Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAR 0 0 01 6 0 0 6 9 1 (800)424-9300 014054450 JJ K <br /> 5.Generreto;pana an:maxngAnw�g' Generators Site Address Of different than mailing address) <br /> TRACY fv1AZDA-TFtA121 <br /> 2680 AUTO PLAZA WAY <br /> TRACY CA 95304 <br /> Generator's Phone: a 209 820-7800 <br /> fi Tm;.Mn:r 1 Com dny tr' U.S.EPA 10 Numtor <br /> ABBUR ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7 T(onapat_r:Company N.;mc U.S.EPA It)!.umbar <br /> 8.Desigmled FADVy Ntmte and ShA.dom-ss I U.S.EPA ID Numbor <br /> EVOQUA WATER TECHNOLOGIES LLC <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 CAD097030993 <br /> Facillty's Phone: (323)277-1500 i <br /> 91 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Conlalners 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Typa Quenll[y WWoI. 13.Waste Codes <br /> I. NON-RCRA HAZARDOUS WASTE SOLID,(BRAKE LATHE SHAVINGS) 181 <br /> i D <br /> w 2 <br /> � I <br /> I <br /> 4 `I I <br /> I l <br /> 14.'p,I jalHandlingInslruciionsandA.ddiiionalInfomraron <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 NAERG#981:171*PROFILE/#961:AP199/000 BRAKE LATHE <br /> SHAVINGS* *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT ' <br /> 14- L � <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately drscnbed above by the proper shippiq name,and are classified,paclaged• <br /> marked and fabeled/ptacarded,and are In all respects In proper condition for transport according to apOlrable International and nallona gavemmontal regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify[hat the waste minlmizallon statement identified In 40 CFR 2V-27(a)Or I am a large quant0y gererdlnr)or(np •t am e: quantity generator)is true. <br /> Gcnuatdis101trJor'jngtu�t�mc /'�� Slgrcll`�.e Month Day Year <br /> 15.Inrcmat;oral Iii mwnis <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylenl: <br /> Trosyenar eipnatuie(W oy,,orls only): Data leaving U.S <br /> W 17.Transporter Acknowledgment of Recelpt of Materials <br /> Tranepa 1 Pr mGSigorsrfpMonth Day Your <br /> O <br /> I� <br /> ransporter2 Prinredryped Name Signalure Month Day Year <br /> t- <br /> 18.Discrepancy II�� <br /> 1Ba.Discrepancy IndIcallon Space 1:1 Quantity OType 1:1 Residue ❑Partial Rejection ❑Full Rejection <br /> Maniresl Reference Number. <br /> 16b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> U <br /> L<1 Facility's Phone: <br /> w 18c.Signature of Anemate FarAry(aGonerator) Month Day Year <br /> d <br /> z <br /> 03 19,Hazardous Waste Report Management Method Codes(f.e.,codes forhazardous waste treatment,disposal,and reoy*g systems) <br /> 0 i. — � ( 2 z 4. <br /> 20.Gc< tc F.vfil,, <br /> Owner orOpe ator.CedIlIcalion of race?o!of hazardous materials covered by the manifestduepl as rtded In Item 18a <br /> P 1llfYF'Dt'a McnIn Day Y ar <br /> EPA Form 8700-22(Rev.3.05) Previous editforls are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />