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Form Aporoved. OMB No. 2060-0039 <br />EPA Form 8700-22 (Rev. 3-05) Pfavious editions are obsolete. DESIGNATED FACILITY TO DESTIOATION STATE (IF REQUIRED) <br />A, <br />UNIFORM HAZARDOUS <br />1. Generator ID Number I t <br />L Page I of <br />Respo <br />3. Emergency nse Ph" <br />* umber <br />4. men"(racidalt N <br />014051358 JJK <br />WASTE MANIFEST <br />CAD 982348930 <br />1 <br />(800) 4249300 <br />5, Goteroto(s Name and Address Goneraliars Sh 72FZ-(W different (hen malliv addro" <br />NJ MCCUTDI-IMINC <br />123 W SONORA STREET <br />STOCKrON CA 95203 <br />Generators Phone: 209 46&9704 <br />B.Transpotiet I Company Name U.S, EP ID Ru7i <br />ASBURY ENVIRONMENTAL SERVICES CAD 028277036 <br />7, Transpodu 2 Company Rm—a U.S, EPA ID Number <br />8, Designated Faa4y Name and Site Address U.S. EPA ID NWTOW <br />EVOQUA WATER TECHNOLOGIES LLC <br />5375 SOUTH BOYLE AVENUE <br />LOS ANGELES CA 90058 CAD 097030993 <br />Facility's Phone: 323)277-1500 <br />9b. U.S. DOT Description (including Proper Shipping Name, Huard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (6 any)) <br />Quantity <br />WLIVOI. <br />NON-RCRA HAZARDOUS WASTE, SOLID (METAL GRINDINGS) <br />181 j� <br />Ix <br />D N <br />/000 <br />P <br />LU <br />2.. MEFFAt"IMN" SA <br />Uj <br />apt <br />I.—NONMORA HAZARDOUS WASTE. SOLID (PAINT CHIPS) <br />181 <br />D IV: <br />0 0 <br />P <br />4- NON-RCRA HAZARDOUS WASTE, SOLID (PAINT BOOTH FILTERS) <br />352 <br />D M <br />ZA <br />--n— <br />% Special Harding Instructions and AdditioiWTformation <br />EMERGENCY CONTACT: CHEMTREG 1-800-4249300 NAERG# 9131:171, 982. 17: <br />UN <br />AP203469 METAL GRINDINGS, 9132: AP203469 METAL GRINDINGS, 9133: AP203470 PAINT - AP203524 P' <br />BOOTH FILTERS * PO# AJ 10218066 *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT-SXFO 17 <br />15. GF-WERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately descri0,60 above by the proper shipping name, and are dosslified. packaged, <br />marked and labeled/placarded, and are in al respects In proper condition for transport according to applicable International and natioial governmental regulations. If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the (me of the attached EPAAcknowladgmerft of Consent <br />I certify that the waste minimization statement Idond led in 40 CFR 262.27(s) (K I am a large quantity generator) or (b) (111 am quantity 9a. --uv-- <br />...... <br />c,onorstoes/offeroes Prft,tWTy;ped month Year <br />/7 11 IT <br />:�� - I <br />!ZTne <br />b I si <br />46yt"'l -tL <br />W-A <br />% Internationai Shipments <br />' 1:1 knprt I. FIE.P.d from U.S. Port of enbylexit <br />3; <br />Transporter signature (for exports only); Date leavIng U.S2 <br />w17. <br />TransporterAcknowledgment of Receipt of Materials <br />i2 <br />Tran PrintedifTypis! Nut"rr."th Day Year <br />1/0 1.111 <br />CL <br />co <br />Transporter 2 Printed[17ypeO Name Moritit Day Year <br />16. Discrepancy <br />18a. Discrepancy Indication Space El Type Ej❑El Full Rejection <br />Quantity Residue Partial Rejection <br />em <br />Zlt-o-, q,,S, anOrrat ran N' <br />REG Em- I V M <br />Faditys Phone: <br />month Day Year <br />Go <br />19. Hazardous Waste Report Management Method Codes (t*, codes for hazardous waste treatment disposal, and �Wl 11 tJ NM L N A L H <br />-13. <br />J RV! <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materia covered by the manifest except as noted in Rvi4 18s ---NY Year <br />p an <br />Printed (Typed Name <br />EPA Form 8700-22 (Rev. 3-05) Pfavious editions are obsolete. DESIGNATED FACILITY TO DESTIOATION STATE (IF REQUIRED) <br />