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017792479JJK <br /> Please print or type-(Form des gned for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0639 <br /> UNIFORM WARDOUS1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.ManifestTrackrng Number/� ^y �( <br /> WASTE MANIFEST 0 1 7 7 9 2 4 1 9 JJK <br /> v <br /> 5.Generators Name and Mailing Address Gene cars ite ress If ditfarent than malrrng address) <br /> C..RTIFIEp CO>LJSI0N CENTER_.. <br /> G7710 MURRAY DRIVE _ <br /> Genera%affl TON CA 95210 <br /> no: 2099302309 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 'ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U-S.EPA I D Number <br /> 8,Designated Facility Name and SiteAddress U.S.EPA ID Number <br /> US ECOLOGY VERNON INC <br /> 5375 SOUTH BOYLE AVENUE <br /> FacIllt'( w NGELES CA 90058 CAD097030993 <br /> ga, 9b:U.S.DOTescr n(Including Proper Shipping Name,Hazard Class,ID Number, 110.Contalnera 11,Total 12.Unit 13 VOsta Codes <br /> HM and Padding Group(d any)) No. Type Quantity WtNoi., <br /> i. <br /> c NON-RCRA HAZARDOUS WASTE.SOLD(RONDO DUST) <br /> DM �� P <br /> M 2. <br /> LU <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions and Additional Intonnation ren nr,fA <br /> EMERGENCY CONTACT:CHEMTREC 1,800-4249300 WOES TERMINAL:CERES CS *PROFILE 09Bi:588536 BONDO DUSIT�*-�J13.t`[O <br /> P50D-00054319*APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT #U" X5J <br /> 15. GFNERATOR'SIOFFEROR'S CERTINCAUDN:I hereby declare that the contents of this consgnmerd are fully and accuretelydes&bed above by the proper shipping name,and are classified,packaged, <br /> marked and labdedlplecarded,and are in al respects in proper conditian for transport according to appGaable international and national governmental regulations.if export shipment and I am 0o Primary <br /> Fxpode,I cedffy that the conferds of this consgnment confarm to the terms of the attached EPAAdawwiedgmenl of Cope <br /> Icertifythat towaslaminimizabonstatementidentffedin40CFR 262.27(a)(if Iamalarge quanbtygenerator) r{b} as generabor}Istrue. <br /> Ge esfOrejoftPrintedrrypedN Month Day Year <br /> p a2 <br /> -j T6.International Shipments <br /> F- ❑ImpadtoU.& ❑Export from US. Portolentrylexik <br /> Transporter slgnatura(for exports only): Date leaving U.S.: <br /> W 17.TmnspDluAdmaMedgmentafReceiplafMatedale <br /> Tmspoq ld Na a Signature Month Day Year <br /> 9L L(i a t� <br /> aTransp ntedliyped Kome S gnature Morph Day Year <br /> 115 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 1&.Ake"Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Facilibfs Phone: <br /> W 180.Signature ofAltemate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(t.e..codes lorhazardous waste treatrnent,disposal,and recycling systems) <br /> 0 1. 2, 3 4. <br /> 20.Designated Facility Owner or Operator.Certification of recetpt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pnntedlrypad Name .r- S gnat re Month Day Year <br /> , � loq 1 13119; <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY T ST[NATIDN STATE(IF REQUIRED) <br />