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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAR 0 0 0 1 6 0 0 6 9 1 (800)4249300 014057934 JJ K <br /> 5.GeneralpLs_Ijme a��laifjng F� ss21 Generator's Site Address(If different than mailing address) <br /> 2680 AUTO PLAZA WAY <br /> TRACY CA 95304 <br /> Generators Phone: 209 820-7800 <br /> 6.Tansp AS6UR7fENV�RONMENTALSERVICES U.S.EPAlDNumber i <br /> CAD028277036 <br /> 7.Transporter 2 Company Name a U.S.EPA ID Number <br /> 6 Des tVOQUA WAT€R TECHNOLOGIES LLC U.S.EPA ID Number <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 <br /> FaaTitys Phone: (323)277-1500 CAD097O3O993 <br /> ga gb.U.S.DOT Description(Including Proper Shipping Name,Hazard Gass,ID Number, 10.Contah ers 11.Total 12-Unit <br /> HM and Packing Group(if any)) No. Type Quantity WW01. 13.Waste Codes <br /> 1. N N-RCRA HAZARDOUS WASTE SOLID,(BRAKE LATHE SHAVINGS) 181 I i <br /> 0 <br /> D 'goo P I i <br /> r <br /> z 2.LU <br /> i <br /> 1 <br /> 3. ) <br /> t <br /> I <br /> 4, <br /> i <br /> i <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 NAERG#9131:171 *PROFILE#961:AP199000 BRAKE LATHE <br /> SHAVINGS *P500-00017243 *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> `` 201 /X&O � <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this mnsignmeni are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects In proper condition for transport according to applicable international and national governmental 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 EPAAd=wledgment of Conse <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(rf I am a large quantity generator)Dr )(Ifl a U quantity generator)is true. <br /> Generalors10 enDrs Prinmtrfped Name Signature Month Day Year <br /> 1/0 labllb <br /> J16.International Shipments <br /> F- ❑Import to U.S. El Fport from U.S_ Port of entrylexib <br /> Transporter signature(for exports only): Date leaving U.S.: i <br /> MX 17.Transporter Acknowledgment of Receipt of Materials <br /> Tcn 1 Printedtryped Name Signature Month Day Year <br /> 0 <br /> v 1 <br /> a <br /> Tran4oner2 PrintedfTypedName ure Month Day Year <br /> � I <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space ❑ Quantity` 1:1 Type E]Residue ❑Par0al Rejection ❑Full Rejection <br /> Clavit-j(� 6, 4; F7,ck / vo ve z- us vl a�y vev'w►&-Lk-� <br /> Manifest Reference Number. <br /> I6b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> FadlltysPhone: <br /> w 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and recycling systems) I <br /> 0 1, 2 3. 4. <br /> 20.Designated Facility Owner or rator.CerUfiation of receipt of hazardous matedals covered by the manifest except as noted In Item 16a I <br /> Printe yped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.305) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) i <br />