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Please peril or;pa.(Form dasigned for use on elite(12-pitch)[ypewr11orj Form Approved.OMB No.2050-0039 <br /> 57NIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 r13. mergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C A D 9 8 1 9 6 7 6 8 0 1 (800)424-9300 01- 7791242 JJ K <br /> 5.Generalors Name and Mailing Address Generators Site Address(d different than mailing address) <br /> STOCKTON DODGE INC <br /> 3333 AUTO CENTER CIRCLE <br /> STOCKTON CA 95212 <br /> Generators Phone: 209 477-3668 <br /> G.Thnsporier 1 Company Nance _ U.S.EPA ID Number <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Tromporlor 2 Company Name U.S.EPA ID Number <br /> 8.Designaled 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 I CAD 0 9 7 Q 3 0 9 9 3 <br /> Facility's Phone: 023)"77-1 F <br /> 00 ga• 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wtivol. 13.Waste Codes <br /> 1.NON-RCRA HAZARDOUS WASTE,SOLID(BRAKE LATHE SHAVINGS) <br /> ` DM L� P <br /> t z <br /> ua <br /> 4: <br /> 14.3pecdrt HprtdVq InsbucUons andAddliwtat Infoftlion' <br /> EMERGENCY CONTACT:CHEMTREC 1=800-4249300 WOES TERMINAL CERES C5 '"PROFILE#9151•;:14=013-01 BRANE <br /> LATHE SHAVIGNS*PSOO-00055189 x APPROPRIATE PERSONAL PROTECTIVdEQUIPMENT <br /> 1S.t GF.NERAT0R=FFER0R'5 CERTIFICATION:I hemby declare that Me corlterb of this mnslgrin"I are 8dtyand accurately dexr[brWd abova by Iho propetshippinQ henna,and aro ddswdd;parkagA <br /> ;irarYnd and l4sladl &vdod,and are In all raspeds•In propos cordbn for imngw DomWing b awP=bto Jntpm jweimd nagwal goverrvncnfal ragufaws.If QVM-shlpimnf arldl sitr015 ftwry, <br /> r ff plot,I certify That Ileo contents of this m=s r rmnl conform to 0 tomr3 df the olwdred EPRAtlrtaxlodflmen[of <br /> kprtiip Otat tlm waste mWndzallon atalomenl&lentfed In 40 GFR 202.27(a)0 Tam a large quaradlygencral 'm a aH enoralnr)is hue. <br /> G rJ lcror s Printedll-ypW Name l+ -krDay Ye <br /> i r• , <br /> ar <br /> f� Z <br /> r ilkInlarm SNPmams ❑ rt b 0 <br /> ImpoU.S. Erpod from U.S, Pori of enhylexrt <br /> Trrnrsporlor signstora(Ior expals only-. Dale U.S.; — <br /> w 17.TrampartorAd oAs dvm[of Recslpt of Matpials t <br /> T I Pnnkw sero Sinature <br /> [� 9P re Moran pay Year fti 7 <br /> Tr3FRparfbr 2 Pdnr p d Name Signahire- Oonth bay w Y l <br /> Ix <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space 0 Quantity 0 Type ❑Residue 0 Partial Re)Cctlon ❑Ful[Re)ection <br /> Alan fc+sl Reference Number. <br /> 13b-Allemale Fadly(or GoricrM) U.S.EPA ID Numbw <br /> vs <br /> U <br /> w Faedity's phone: <br /> W 18c,Sfgnalura of Alternate Fndlrty(or Genorntof) lNonfh Day Year <br /> z <br /> 05 <br /> rn 19.Hazardous Waste Report Managomonl Met*Codes(i.e.,codes for hazardous waste Iroalmenl oispvsH,and recycling systems) <br /> O 1. Z 3. 4. <br /> 20.❑esirgnated Fac1ty Owner or OpeMWr Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Prntedliyped Namo f 5ig61turr morgh Drry Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IK REQUIRED) <br />