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E <br />Please 0*0�. �rm designed for use on elite (12-pitchl tvnewriterI <br />Fnrm AhnrnvAd 01VIA Nn zsn-nniq <br />U'Wr'OrM 61UU-ZZ (KMV.;$-US) FreVIOUS Cattle" are Obsolete. DESIG14ATED FACILITY TO DESfINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS 1. Generate, ID Number 12.12 <br />Response Phone14. <br />Manifest Tracking Number <br />WASTE MANIFEST C A 9 8 2 3 4 1 8 9_.., 3., .0 1 <br />1 D <br />124-9300 - <br />1 014058229 "'JA <br />5. Goneralor's Name and MaNq Address Generates SM Address (ff ditlerant then rnaliIng address) <br />NJ MCMUCHM INC , <br />123 V SONORA STRM�,,. <br />STOCO'CA 95203' <br />KTN <br />Goneratoes Phone: <br />6, Transporter I Company Nam U.S. EPA tD Number <br />ASBURY ENVIRONMTAL SERV'ICES' Z A D 0 2110 2 71 7-0 <br />7 Transponar 2 Company Name U.S. EPA ID Number <br />8. Designated Facility Name and Site Address U.S, EPA ID Number <br />EVIJA -VATER TECHNOLOGIES LLC <br />53'75 SOUTH BOYLE AVENUE <br />-LOS ANGELES CA 90058 <br />C— <br />Facility's Phone: 02M 277-1600 A D 0 9,3_0 3 0 9'9 3 <br />9a, <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class,* ID Number, <br />10. Containers <br />it. Total <br />12, Unit <br />HM <br />and Packing Group (if any)) <br />Quantity <br />WL/Vol. <br />13. Waste Codes <br />NO. <br />Type <br />0 <br />=—PMA IMAMILUMOUS VASTEr SOLID (PAINT BOOTH <br />352 <br />cl <br />FILTERS) <br />2. <br />3, <br />4. <br />14. Special Handling lnstrucne �and Additional Wo_natio� <br />4 <br />A <br />WERGENCY, CONTACT. , CHMTREC. 1-800-424-9300 NAMkof,.M 171 11&# 9BI <br />AP20SS24 PAINT BOOTA FILTERS E04 A110206190 -APPROPRIATE PERSONAL -1'P <br />E�UIPHENT, Rn �2q/2 <br />A <br />16. GENERATOtV$fOrFCROr,SCERTtrICAT*N-.1 hereby declare that the contents of this conalgamerrt are fully and accuratellydes cigbed above by the proper shipping name, and am clasoffied, psckned, <br />matked and laboled1placarded, and am in a8ssixe:6 In iprolpercondlilen for transpottacoardIng to applicable International and national governmental regulations. If export shipment and (am &a Pdmary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAdmmNwpmt of Consent. <br />I cedify that the waste minimization stalwned Iderifflod In 40 CFR 26227(a) (I I am a Woo quantity generator) or (b) (If I am a small quantky generator) Is true. <br />Teneratoes/Offerot's Nntedrfyped Name Signature Month Day War <br />M,:;Aw A/A14" I �mfI4�6eh,-, ILIA/fl/i- <br />—Shipments <br />_j <br />16, Intemabonal - V_ <br />0 'import to U.S. LJ Export from U.S. Po of entryfaxit: <br />R; <br />-Transparlor signature (forexports only): Date leaving U.S.: <br />LW <br />17, Transporter Acknowledgment of Receipt of Materials <br />0 <br />Trans r I Pfintodffyped Name Signature month Day year <br />CL. <br />0 Gs <br />< <br />Transporler2 rin /Typedzv���� 7 C�;nature month Day Year <br />18. Discrepancy <br />189. Discrepancy Indication Space ElQuantly r -]Type ❑ Residue ❑ Partial Rejection El Full Refection <br />18b. Aitemats Facility (or Generator)MrU,& EPA ID Number <br />LA <br />=4 <br />. I V Ln U <br />Facility, Ph a: <br />LU <br />18c, Signalwo of Alternate Mity (or —Generator) Month Day Yaar <br />1prwaAr: TAI WCAD <br />19. liazamous Waste Report Management Meftiod Codes V.e., codes for hazardous waste treatment disposal, <br />LU <br />2. <br />20. Designated Facility Owner 6r Operator: Certification of receipt of hazardous materials covered by the merged except as noted In Item 18a <br />U'Wr'OrM 61UU-ZZ (KMV.;$-US) FreVIOUS Cattle" are Obsolete. DESIG14ATED FACILITY TO DESfINATION STATE (IF REQUIRED) <br />