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5. <br /> T� <br /> Please print ortpe.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMS No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Genetalor lD dumber - 2. age 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C A L 0 0 0 3 7 1 2 1 3 1 (800) 4249300 01817 0 2 8 7 J J K <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> CERTIFIED COLLISION CENTER <br /> 7710 MURRAY DRIVE <br /> STOCKFON CA 95210 <br /> Generators Phone: 209 478-9971. <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 /> 9a 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WtNol. <br /> 0 1.NON-RCRA HAZARDOUS WASTE,SOLID(RONDO DUST/DEBRIS) 352 <br /> I DM r P <br /> Ili <br /> Z 2. <br /> LU <br /> t7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL:CERES C5 NAERG#981: 171 *PROFILE#9131 <br /> 620910 BONDO DUST/DEBRIS'P500-00087260 *APPROPRIATE PPE EQUIP <br /> 15, GENERATOIT&OF€EROR'S CERTIFICATION; I hereby declare that the contents of this consignment are tufty and accurately described above by the groper shipping name,and are classified,pada <br /> marked and labole ftlacarded,and are in all fespects in proper condition fortransport accprdng to applicable International and national governmental regulations.If export shipment and I am the Primacy <br /> EVartt r,I certify Ihat the contents of this consignment conform tote terms of the attached EPAAcknowledgment of Consent <br /> I certify that the waste minimtz4fian statement identified in 40 Cl 262.27(a)(f I am a large quantity generatof)or(b)(if I am a small quantity generator)is hire. <br /> Gen torslOHefor s Printed7CypeQ Nam; <br /> G�2nSign lure �7.� Month flay Yea[' <br /> 41 ta- 1 /lrvrn <br /> 16.Intemationat Shipments <br /> Z ❑Impori to U.S. ❑Export from U.S. Portof entry/exit <br /> Z Transporter signature(far exports only): Date leaving U.S.: <br /> 17.TransporWrAcknow"meni of Receipt of Mateiials <br /> M <br /> ted�f N eLC Signature 'til4rith Dq �(�r <br /> O <br /> 1t L13,111-11 <br /> Transporter PrintedlT n* Signature MorM Day <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quan' Type ❑ ❑ 1 ❑Full Rejeatiorf <br /> ttty ❑T e Residue Partial Rejection <br /> Manifest Reference Number- <br /> 18b.Attemate Facility(or Generator) U.S.EPA ID Number <br /> U _ <br /> Facility's Phone: <br /> 18c.Signature of Alternate Facility(or Generator) Month 'Day Year <br /> a <br /> z <br /> 19.Hazardous Waste.Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> W 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 18a <br /> Printed i ed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />