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Please print or type-(Form designed for use on'elite(12-pitch)typewwrter.) Form Approved.QMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Fhone 4.Manifest Tracking Number WASTE MANIFEST C A L 0 003,586,31 1 (800)424-9300 7791550 JJ K 5.Generators Name and Mailing Address Generator's Site Address(If different than mailing address) D&D LIFT TRUCK INC- DDL_-001 3820 RHONDA COURT TRACY CA 95304 Generators Phone: 510 719-3557 6.Transporter 1 Company Name U.S.EPA ID Number ASBURY ENVIRONMENTAL SERVICES C A D 0 2 8 2 3'6 7.Transporter 2,Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number US ECOLOGY VERNON INC 5375 SOUTH BOYLE AVENUE LOS ANGELES CA 90058 GADO 9 1'0 3 0 9 9 3 Facilitys Phone: (323)277-1500 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11-Tat ai twtjvol. 12.Unit HM and Packing Group{if any)) 13.Waste Codes No. Type Quantity t. NON-RCRA HAZARDOUS WASTE.SOLID PLY SOLID, PAPER FILTERS) a 352 z 2. C7 3. ! 4. i E 14.Special Handling Instructions and AdditionaE Information EMERGENCY CONTACT :CHEMTREC 1-8017-4249300 *PROFILE#9B1: P211552 OILYSOLID, PAPER FILTERS APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT 15. GENERATOR'SIOFPEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassified,packaged, marked and labeledlplacarded and are in all respects in proper condition for transport according to applicable intemationai and national governmental regulations.If export shipment and I am the Primary Exporter,I certify Ihat the.contents of this consignment confoim to the terms of the attached EPAAcknowledgment of Consent I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. en lorslOfferors PrintedlT d Name igrr re Month Day Year —r 16.Interrbitional Shipments F— ❑Importtc U.S. ❑Export from U.S. Port of entrllexi Trans otter signature(for exports only): Date leaving U.S.: 17,TransporterAcknowledgment of Receipt of Materials Zn f T sorter 1 Pri ted/Ty Name S7gnarre - - - Month-- Day YearIL�Z-� I - CL o 3t 17 Tran otter 2 Pr nted ped Name Signature Month Day Year F- 18.Discrepancy 18a.Discrepancy Indicai on SpaceQuantity Type Residue ❑Partial Rejection ❑Futl Rejection ❑ ❑ ❑ Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number U Facility's Phone: w 18c.Signature ofAltemate Facility(or Generator) Month Day Year Q 19.Hazardous Waste Report Management Method Codes(i.e.,codus for hazardous waste treatment,disposal,and recycling systerps) O 1' 2. 3. 14. 20.Designated Facility Owner or Operator:Cerlificafion of receipt of hazardous materials covered by the manifest except as noted in Item 18a PdntedlTyped Name Signature Month =.,Day Year EPA Form 6700-22(Rev.3-05) Previous editions are obsolete. DFSIGNATED FACILITY(TO DESTINATION STATE (IF REQUIRED) RY(;