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Please print or tyke.(Farm deslgticd for use on elile(12-pion)cylx-wlmor.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 cf 3.Errargen_;P.esperse Flwnr a.hlanlfestTraO..ing Number <br /> WASTE MANIFEST CAR 0 0 0 1 6 0 0 6 9 (800)424,-9300 116772652 JJ K <br /> 5.Gene t t :urS I jai;ingtJrJd ys; Ganeralo's Site Address(d different than mailing address) <br /> 2680 AUTO PLAZA WAY <br /> TRACY CA 95304 — <br /> Generators Phone: 209 820.7800 <br /> F.T;-'r;40rtpr 1 Cpnipany Narm± US.EPA ID Number <br /> A.311 Fr Ei'd:'IRONMENTALSERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> T.Transporter 2 Company Name U.S EPA ID Number <br /> 8.Designaat�ed F ry Name and SituA ddress U.S.EPA ID Number <br /> US LDGYVC-RNON' INC <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90055 CAD 0 9 7 0 3 0 9 9 3 <br /> Facilitys Phone: (323)277-1500 <br /> ga. 91b.U.S.DCT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unlit <br /> HM and Packing Group(d any)) 13.Waste Codes <br /> No. Type Quamiry NRNaI, <br /> 1. NUM-RCRA HAZARDOUS WASTE SOLID,(BRAKE LATHE SHAVINGS) 181 <br /> D NJ IyUC� P <br /> w <br /> z 2 <br /> w <br /> c� <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additboal 10onnation <br /> EMERGENCY CONTACT:CHEMTREC 1-800424-9300 NAERG#961:171 *PROFILE#9B1:AP199000 BRAKE LATHE <br /> SHAVINGS *'P500-00027904 *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> 7y � 3� 3oes <br /> 15. GEN ERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment erefully and acc i 41ely described above by the proper shipping name,and am dasslfied,packaged, <br /> marked and labeledlplacarded,and are in all respects In proper condition for transport according to applicable International and national governmental regulations.If export shipment and(am the Primary <br /> Exporter,I certify that the contents of this consignment confoma to the terms of the attached EPAAcknowledgmenlof C went. <br /> I certify that the waste minimization statement Identified In 40 CFR 262.27(a)(f I am a large quay lily generator)or I am a small 9&y genetalof)Is true. <br /> Genartarsl0fferors PrintadJT Num: Signature <br /> 7.tomh Dray Year <br /> '-, <br /> —1 16.Intemallonal Shipments <br /> F— ❑Import to U.S. ❑Export from U.S. Porto !exit: <br /> z Transporter signature(for exports only): Dale leaving U.S.: <br /> w 17.TransporterAdmowledgment of Receipt of Materials <br /> 'irm 1 PriMadliy-Pu Name. Signature hlJnm Day Y,!a' <br /> Qransportor 2 PrinladlTyp•d Na naNre Month Day Year <br /> M <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space 1:1 Quanlity El Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Refwenm Number. <br /> 18b.Affc4nrde Facllky(of Generator) U-S.EPA 1D%.Vnb•:r <br /> J_ <br /> �U <br /> Faclfilys Phoma: <br /> w <br /> 18c.Signature ofAdiemate Facility(orGenerator) Month Day Year <br /> a <br /> z <br /> 19.Hazy dou NJaste Report Management Method Codes(I.e.,codes for hazardous vraste treatment,disposal,and recycling systems) <br /> 1. 2 3. 4- <br /> 20.Designated Facility Omer or Qpe anor.Certification of recelpl of hazardous materials covered by the manifest except as noted In Item 18a <br /> 1100.47VIO Flame Signature C� t1=1 Day Year <br /> EPA Form 8700.22(P-v 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />