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s Please print or type.(Form resigned for use on elite(12-1 typewriter.) Form Approved.OMB No.2050.0039 ' UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 3 7 7 5 5 2 1 (800)424-9300 010863459 JJ K 6.Gatm+rator's Name and Mailing Addrass Generator's Site Address(if dilletent than mailing address) TRACY VW INC DBA TRACY VOLKSWAGEN 2266 KITTYHAWK ROAD LIVERMORE CA 94551 2605 AUTO PLAZA WAY Generror's Phone: 925 456.1281 TRACY CA 95304 6 Trnnsnorter 1 Cornpany Name U.S.EPA ID Number ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 7 Transportur 2 Company Name U S.EPA ID Number 8.Designated Fac'11ty Name and Site Address U.S.EPA ID Number EVOQUA WATER TECHNOLOGIES LLC 5375 SOUTH BOYLE AVENUE LOS ANGELES CA 90058 CAD 0 9 7 0 3 0 9 9 3 Facility's Phone: (323)277-1500 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Contaners 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.rvol. 13.Waste Codes t' NON-RCRA HAZARDOUS WASTE.SOLID,(OILY PAPER FILTERS) 352 D IV P w 2. [l CEV-EO I 3 j i 4 EINN' RONNIENALIIIIIi I)l': :VR F IIE.. I ._ 14.Spscrai hlandlinq Instrutdris and Additional Information EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 NAERG#9B1:171 *PROFILE#9B1; P209259 OILY PAPER FILTERS APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT ----"'� 19�1-be / S X23v�t 15. GEN ERA7OR'S10FFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accuratelydascrlbad above by the proper shipping name,and are classified,packaged, 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, Exporter,I codify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I cer,h,that the waste minimization statement Identified in 40 CFR 262 27(aj(if I am a large quantity generator)or(b) I am a all uantity onrrstnri is We. Generator gOffenx's Printed/Typed Name Signature n Month /Daly,+ Year 16.International Shipments ❑Import to U.S. ❑Export from U. oil of z — Transporter signature(for exports only): Date leaving US.: 17,Transporter Acknowledgment of Receipt of Materials Trarsp :r 1 PnntedTyped Natne Signature Month Day Year CL z Trans�poner 2 Ante yped iStgnatura Month Day Year a 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity [71 Type 1:1 Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature ofAltemate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2. 3. 4. 20.Dossrtnated Facrity Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a Pdnted/7yped Name , ._ Signature Month Day Year as �� EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FAOIL , TO DESTINATION STATE(IF REQUIRED)