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E <br />�a <br />, VR49WWki[38. (Form designed for use on ellto (12 -pitch) typewriter. <br />UNIFORM HAZARDOUS 1 - . - Generator 10 Number 2. Page t of 3, Emotgoncy Resix, <br />WASTE MANIFEST C A D 9 8 2 3 4 8 9 3 0 1 (800)"424 <br />5. GonaraWs Name !���wmWs �Mdr <br />Is <br />,J MCCUM " Mr - <br />123 V SONORA-STREET <br />STOC MON CA 95203 <br />Generator's Phorw. 209 466-9704 <br />6. Trtinspodet I Company R—we <br />ASBUILY ENVIRONMENTAL SEM(=S <br />7. Tiansponef 2 Company Name <br />OMB No. 2050.0039 <br />8 JJK I <br />G A U 0 Z -13 .. Z -11711 7 0 <br />8. Designated Facility Nameand Site Adddress U.S. EPA ID Number <br />W10QUA WATER TEMIOLMIES LLC <br />5375 SOUTH BOYLE AVENUE <br />LOS ANGELES CA 90050 C A -D 0 ".9 7 0 3 0 9:9 3 <br />Facility'sPhons: (323) 277-1500 <br />ga. <br />9b. U.S. DOT Description (IndudIng Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13, Waste Codes <br />No. <br />Type <br />HIM <br />and Packing Group (If any)) <br />Quantity <br />WuVol. <br />Q D (01T.V D-Rl QnT.I <br />--E—00T'T <br />? <br />D, H <br />P <br />W <br />� 10N-RCRA HAZARDOUS nSTE, SOLID METAL <br />181 <br />D'K <br />3, <br />NOW-RCRA HAZARMUS WASTE, SOLID (PAINT CHIPS) <br />180 <br />1, <br />4, <br />X, —11, a �'r <br />"'— <br />5A 4 <br />and Additional Information <br />MERCTEXY CONTACT " CHWREC 1 -. 171i .9 B3t,.1 1 <br />k .PFILE # 9BI I AP200514 'IF OILY SOLIDS9B2 .-AP203469 ,XZTAL GRINDINGSk,983, 111 <br />AP203470 PAINT CHIPS'*'PO# A110206189 APPROPRIATEJERSO)9AL PRO TECTIVE'VIP MOT <br />15, GENERATORWOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and labelediplacarded, and are In all respects in proper condition for transport according to applicable International and national governmental regulations. 9 export shipment and I am the Primary <br />Exporter, I ce" that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br />I certify that the waste mInImIzatlon statement Identified in 40 CFR 262.27(a) (If I am a large quantity, generator) or (b) (91 am a small quantity generator) Is true. <br />iti, international shipments <br />r— -j �Ij import to U.S. <br />K- Transporter signature (kir exports only): <br />17, Transporter Acknowledgment of Receipt of Mata als <br />—Trams 1 Ptintecypeo <br />CL e. v <br />18. Discrepancy <br />18a. Discrepancy Indication Space F1 Quantity ❑ Type <br />18b. Alternate Facility (or Generator) <br />A- Facilitys Phone: <br />LO18c. Signature ol'Aftemag Facility (or Generator) <br />Ll <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste <br />LU 1 2. <br />20. Design ted F.cllfty Owner or Operator. Certification of recelpi of hazardous mat6dalsla <br />pri y Name <br />Alp -"n <br />U.S. <br />Date <br />LJ Residue <br />the manifest except as noted In Item 18a <br />Partial Rejection "Full Rejection <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO [DESTINATION STATE (IF REQUIRED) <br />