Laserfiche WebLink
Please prif11 or type.(Foran dos,ped for use on elite(12-pitch)typewriter.) Fotm Approved.OMB No.2050-0039 <br /> - UNIFORM HAZARDOUS 1.Generator ID Number' 2.Page 1 of 1 3.Emergency Response Phone 4,Manilest Tracking Number W <br /> WASTE MANIFEST C A D 9 8 19 6 7 6 8 0 1 (800)424-9300 017792010 JJK <br /> 5.Generator's Name and Mailing Address GerieratoYs Site Address(if different than mailing address) <br /> STOCKTON DODGE INC <br /> 3333 AUTO CENTER CIRCLE <br /> STOCKTON CA 95212 <br /> Generator's Phone: 209 477-3668 <br /> 8,Transporter 1 Company Namo U.S,EPA ID Number <br /> ASBURY ENVIRONMENTAL SERVICES 1 , CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Tra erg Company H,,ff U.S EPA tO Nemtur <br /> 8.Designated Fucility Namr,and Site Address U.S•EPA[0 Number <br /> US ECOLOGY VERNON INC <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 CAD097030993 <br /> FacililysPhone: (323)277.1500 <br /> ga. 9b.,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Cordeln'ers11.Total 12:Unit <br /> HM and Packing Group(if any)) No. Type Quantity WtNol. 13.Waste Codes <br /> 1•NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLID,PAPER FILTERS) r D ' 1(�q 352 <br /> C3 (, <br /> P <br /> 2. <br /> 1J.k <br /> [7 <br /> 3- <br /> 4. <br /> 14.Special Hanging trutwtinns and Add Owmi tnforma0on <br /> EMERGENCY CON-TACT:CHEMTREC 1-800-4249300 WOES TERMINAL::CERES CS *.PROFILE#861:P211550 OILY SOLID, <br /> :.A APER FILTERS *P500 00052281*APPI?OPRIATE PERSONAL.:PROTECTIVE EQUIPMENT <br /> 15. GEHERATOR'SIOFFIEROR'S CERTIFICATION:I imruby dodam that Hie wntenis of Cas wnnignnierltam fully and 4=r446y dawrlbW Am by the proper sldpptng rarer,Arid aro cla;si .pod*d, <br /> marked mid InWerllplecrfded,and are fn ait rasped,,In proper corrdNon for immporl actwl0ng lo apokabW Inlama and riallorlal gbvomm6tal retial llms.If export sNp*rA and I A18 the Primary <br /> Fodor.PwAfy that tlm comms of Ctis conslow ant conform to the terms of�alt ed EFA. rat <br /> I oisft that tha waste mWml:ntinn s0lorrmt ldnnliFmd In 40 CFR 262,27(x)(if I err a largo quanlilyr gone r}or a s I guar lty geramtQrj is he. <br /> Genoratoe:!(Nlarats PmrtedfTyped Nemo Signa o o Do 'Pat <br /> � .1G.Iriorria.5orwl5hipmrrrSef� - — <br /> f 1:1lmporl to U.S. ❑E*.M from U.S. Porf'of entry/exit <br /> z Transpwterslgnaium(tar exp a1s Doty): Date lo"g U.S.: 1. <br /> u1.r 17,TrarapoAaAclmowlodgmentofRec000fMalhrla <br /> Trwwparter 1 PrinledlTyped a Sigmitua fdm = -CL <br /> F ai ., '. <br /> Tr,nspprtw 2 PrvucrUrypod N.:rrus Sig iatri o Month Day Yda7 <br /> tr <br /> 1— <br /> 18.Discrepancy <br /> 18a.Discrepancy.Indication Space ❑ Quantity ❑Type [--]Residue ❑Partial Rejection ❑Full Rejection <br /> Arerufesl noferenco Nurnmr. <br /> 18b.Alternate FacAty for Genemw) U-S.EPA ID Number <br /> J_ <br /> C.) <br /> U Fnurlitys Phone: <br /> w IP.c SignApre iA Allemale Faalr/.(a Genrualaf) Idenite Ony Year <br /> Z <br /> to <br /> 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment dispml,and recycling systems) <br /> LLI0 1. 2, 3. 4, <br /> 20.Designated FadRy Owner or Operator.Certification of rorulpt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pon[edfTypod Name Synatwe Month Day Year <br /> p <br /> EPA corm 0700.22(Rev,3.05) Previatrs editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />