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t <br /> I <br /> Please Thor a, orrn deal hail for use on elite 12- Itch i swrller, Form Approved,OMB No.2050-0039 ) <br /> UNIFORM HAZARpOU3 L Generator ID Number 2,Page of 3.Emexgency Rosponse P orre14.Manifest Trac Number <br /> WASTE MANIFEST CAR 0 0 0 0 7 3 5 8 5 1 (800)424-9300 014054411 JJK j <br /> 5,Ger %�La I R A c!n� Conersf0 s Site Addreae(d different than nailing address a <br /> TTNA r FfA078 <br /> 2895 NORTH NAGLEE ROAD { <br /> TRACY CA 95376 1 <br /> Generakea Phone; 209 834-1111 <br /> 8.7HnepoA TWNMENTAL SERVICES G <br /> M8277036 <br /> Transporter I Company Name US.EPA ID Number <br /> a Dealgnato OQ A INORII"ONOLOGIES LLC U.S.EPA ID Number <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 <br /> CAD 0 9 7 0 3 0 9 9 3 <br /> Faclity'a Plane: (323)277-1500 <br /> pa. Db.U.S.DOT Descriptlon(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit 13.Wass Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity WI.W. <br /> 1 ON-RCRA HAZARDOUS WASTE,SOLID RAKE LATHE HAVINGS) <br /> a 181 j. <br /> D P <br /> Z <br /> cn <br /> 3. <br /> 4, <br /> 14. p octal Handling Instructions and AdNonaln orme on <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 NAERG#981:171 *PROFILE#981:AP192217 BRAKE LATHE <br /> SHAVINGS * *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> 15. GENERATOR'SIOFFEROR'9 CERTIFICATION; I horOydeclare Ihat the contents of INs oonelgnmW are hilly and accurately described above by the proper shipping name,and are d6salf ad,packaged, <br /> marked and labelodlplaca-ded,and are in all respects In proper eon0lon for trensprxt according to applicable International and nallonal governmental regulations.If export shipment and i am the Primary <br /> Exporter,l oetilty that the contenls of this consignment conform to Are terms Ortho attached EPAAckrwwledgmenl of Cohsent. <br /> I certify that the waste minimization statement Wenilfled In 40 CFR 26227(a)(If I am a large quantity general")or(b)(III ams small quantity generaiorj Is truo, <br /> Oenoreloe# C n oMliy odrtte. l S ret t T y Year <br /> Ali1 �G <br /> 9,IntemailoR ShIpmon'tr� <br /> Import to U.S. L__t Export kom U.S. Pori of entrylexli; <br /> Transporter algnature(for expels oni Dale leaving U.S.: <br /> 17,TranapoderAcknowledgmentof Receipt of Materials <br /> Trangftr i Iain me S ndlure }Hoath +bray /par <br /> d /5�7 <br /> N <br /> dT. n net 2 Prlrdk(WaAta MAh Day Year <br /> a- <br /> 18.Demxeponcy I�--�1m <br /> 18a,Discrepancy IndleaAOn Space Quardlty ❑Type ❑Residue LJ Parllal Rejection ❑Fud Rejection <br /> Manifest Rotorwtce Number: <br /> 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> c� <br /> L, Fadi ty's Phone: <br /> Be. gnslure of AllametsFacgity or eneralor o ib Day Year <br /> 0 - <br /> 19.Hazardous Waste Report Management Method Codes(I.e.,codas for hazardous waste treatment,disposal,and recycling ayslems) <br /> 1. ( 2. <br /> 2U.Daslgrntl keslllty Owner or OA Y far;Certlficalion of receipt of hazardous materials covered by mho manifest excapt as noted In Item 1Na <br /> Aft .4A Ze� <br /> Priril o Nome igna urs tin Day ear <br /> rg4- I.- 2L - <br /> EPA Form 0700-22(Rev.3-05) Pravlous odillons areobsolele, DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> i <br />