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016870189JJK <br /> Please print or type.(Form designed for use on elite(i2-pitch)typewriter.) Y Form Approved.OMH No.2050-0039 <br /> UNIFORMMANIFEST7S 1i.GenMWrIDKUMWD9876228 2P1age1of IM"o J4114 �g -a a 1768701.89 JJK <br /> mber <br /> WASTE MANIFEST 4 SiSUo <br /> sGtfdW`�V - ANT-BIG172 Generators Site Address(il'ditferenlthan maiGrgaddress) <br /> P.O.BOX 690398 <br /> ST OCKTON CA 95289 3282 AUTO CENTER CIRCLE <br /> nera[ors P}m:n N 209 8704352 STOC=N CA 9521.2 <br /> 1D <br /> Gece�FLal <br /> s.Tran r ri6hONMENTALSERVICEs D.'GM r2-17 03 6 <br /> 7.Transporter 2 Company Name U.S.FPA ID Number <br /> 8.D sg,rq'�edEaol1ttik IlQ$QgA�ttrp�s U.S.EPAID Number <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 CAD 0 9 7 0 3 0 9 9 3 <br /> Fans pt"; (323)277-1500 <br /> 9, 9b.US.DOT Des Wkn[ndll(img Proper Supping Name,Hazard Class,IDNumber, 10.Ca tourers 11.Tota! 12.Unit 13:Waste Codes <br /> HM and Pading Group(if") No. Type Chrahb'ty MAu <br /> a NON-RCRA HAZARDOUA WASTE.SOLID(OILY SOLIDS,OILY PAPER 2 <br /> o FILTERS, EMPTY PAINT CANS) <br /> � l DM P <br /> W <br /> z <br /> 3. <br /> 4. <br /> 14.Speoal Handfmg hatactiurs and Atidtio A Wormatkn <br /> EMERGENCY CONTACT:CHEMTREC 1-804424-9300 WOES TERMINAL:CERES CS NAERG#9B1:171*PROFI.E#9B1: <br /> 603957 OILY SOLIDS,OILY PAPER FILTERS,EMPTY PAINT*P50000069963*APPROPRIATE PPE EQUIPMEN33 70;3/-2- <br /> Z1515. <br /> . GENERATORWFFEROR'SCEKME:AT10N 1herebydKWethatthecontentsoffttscoruOodntamfatlyandao=ttetydesvu7>e0abovebythepWershlppingname,andamedassftd packaged, <br /> marked and Iabeledrplacarded,and aro in all respects In proper condition for transpatacoondmg to appr=ble international and naCrnal gova mnerttal regulations.Itexport d*merd and 1 am the Pmnary <br /> E)podar,I cart lythat the coraerds of tots oenslgrmterl conform to the terns of the adarned FPAAd oWedgment of Consent _ <br /> I certify that the waste minimlzatlon statement ldenGflod In 40 CFR 262.27(a)[dl am a large quantity generator}or(b)(f I am a small quantity generator)Is true. <br /> GeneratofslDterors Pdnledlyped N Signature Month Day Year <br /> 'txShvnents ❑tmpodtu U.S. ❑Fxpod from LLS. Pod of erwextt <br /> Z <br /> Transporter signaWe(for exports arty}. Dobe leaving U.S.: <br /> C 17.TransporterAduowledgmerrtdRoccoofMatertals <br /> a7 er 1 PdntedfTyped Name Signature Month Day Year <br /> O % �l <br /> a <br /> 4 Trargmrter 2 Prfntedi'Typed Name Sigrrahaa Mora Day year <br /> 16.Discrepancy <br /> lea.Daaai=yhtJi=50oSPM ❑ Qaantdy ❑Typo ❑Residua ❑PartialRe)actian ❑FullRejedmr <br /> Manifest Reference Number. <br /> 16b.Altemale Facility(a Generator) U.S.EPA ID Number <br /> a <br /> V <br /> FadRys Pb.: <br /> w 18c.S"ngraturo ofAitemate FacW(or Generator) mom Day Year <br /> d <br /> 2 <br /> N19_Hazardous Waste Report Management Method Codes(Ie.,codes for hazardous waste treatmecd,disposal,and recycling systems) <br /> 0 1. 2 <br /> 20.Designated Fadity Owner or Operator:CerSfrcation of receiptaf hazardous materiats covered by the manifest except as noted In Item 18a <br /> Printed(Typed Name Signature Month Day Year <br /> EPA Form 87W22(Rev_3-06)Previous eMons are obsolete. DFS[GNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />