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Plam print or type. (Form designed for use on elite (12-pitch) typewriter.) Foran Approved. 0Mg No, 2050-0039 <br /> UNIFORM HAZARDOUS 1 • Generator ID Number 2. Page t of 3. Emergency Response Plane 4. fwanffast Tracking Number <br /> WASTE MANIFEST CAR 0 0 0 0 7 3 5 8 5 (800) 424.9300 017696307 J J K <br /> 5. Genaraloes Name and Mailing Address Generator's Site Address (d different than mailing address) <br /> TRACY TOYOTA - NORTH NAGLEE RD <br /> 2895 NORTH NAGLFE ROAD <br /> TRACY CA 95378 <br /> Generator's Phone: 209 8344111 <br /> 6. Transporter 1 Company Name U.S, EPA ID Number <br /> WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 8. Designated Facility Name and Site Address U.S. EPA ID Number <br /> US ECOLOGY VERNON INC <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 CAD 0 9 7 0 3 0 9 9 3 <br /> Facility's Phone: <br /> ga 9b. U.S. DOT Description (including ProperShipping Name, Hazard Class, ID Number, 10, Containers 1t , Total 12. Unit 13. Waste Codes <br /> HM and Packing Group (t any)) No. Type Quantity Wti ol. <br /> 0 1 ' NON-RCRA HAZARDOUS WASTE , SOLID (BRAKE LATHE SHAVINGS) X81. .....: . . . .. .. . .: . . . _. <br /> DMd � P <br /> ui 2. <br /> i <br /> 3. i <br /> 4. <br /> 14. Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT : CHEMTREC 14;M424-9300 WOES TERMINAL: CERES CS NAERG# 981 : 271 * PROFILE # 982 <br /> AP192217 BRAKE LATHE SHAVINGS * P50"0068243 * APPROPRIATE PPE EQUIPMENT � !G <br /> 15. GENERATOR'SIOFFEROR'S CERnFICATION: I herebydedare that the contents of this consignment are tu!ly and accurately described above by the proper shipping name, and are dassified, packaged, <br /> marked and labetedloacarded, and are in all respects in proper condition for transport according to applicable intemationat and national govemmental regulations. It export shipment and I am the Primary <br /> Exporter, Ice* that the contents of this consignment conform to the terms of the attached EPAAdmowledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(x) (t I am a large quantity generates) or (b) (01 am a small gwntity generator) is true. <br /> Generator'srOfferor's Prin Name Signaivr Month Day Year <br /> lz� 126JOAOI <br /> .� 16. International Shipments low <br /> ;. ❑ Import to U.S. ❑ Export from U.S. Port of enbylexil <br /> i 2 Transporter signature (for exports only): Date leaving U .S.: <br /> W 11, TranspoderAcfuwx(edgmentofReceipt ofMaterials <br /> d TiranWey 1 Printedlfyped Nam Sig Month NY Year <br /> a ° . 0 <br /> 4 Transporter 2 Pdntedltyped Name Signa Month Day Year <br /> 18. Dimwancy <br /> 18a, Discrepancy Indication Space © Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> J <br /> LVE Facility's Phone: <br /> 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> LLId <br /> z <br /> 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment disposal, and recycling systems) <br /> Q 1 2. 3. 4. <br /> 20. Designated Facility Owner or Operator, Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Be <br /> PrintedrTyped Name Signature Month Day Year <br />