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<br />Form t pptovei:L OMB No. 2050.0039
<br />Please
<br />FPA rFaml 8700.22 (P.av, 1•05) P;aviov., ..irlir,ri=> obsolete.
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<br />print or tyffe. (Frtrrtl ti�stgn¢
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<br />Page 1 of
<br />3. Emergency Response Phone
<br />4, ManHomTracking Number
<br />UNIFORM HAZARDOUS
<br />1. GeneratorID Number
<br />017791288
<br />JJ K
<br />WASTE MANIFEST
<br />CAD 0 2 8 2 7 7 0 3 6
<br />1
<br />(800)11424-9300
<br />5, Gbneraloc a P�ania arjd }Aatling Address
<br />Generator's Silo Address: Of dilferont than
<br />moiling addross)
<br />ASBURY ENVIRONMENTAL SERVICES
<br />1300 S. SANTA FE AVE
<br />COMPTON CA 90221
<br />"Ger>aralo?a
<br />Phone: 310 886-3400
<br />0. Tranaprtar 1 Comp wf!ytlrm^
<br />U.'v". EPA ID Nnrfit .r
<br />ASBURY ENVIRONMENTAL SERVICES
<br />CAD 0 2 8 2
<br />7 7 0 3 6
<br />7: Tronsorlov 2 Comrpany Nang
<br />U.S. EPA ID f un;tlet
<br />8. Designated Facility Name and Site Address
<br />U,S. EPA ID Number
<br />ASBURY ENVIRONMENTAL SERVICE CERES
<br />1920 MORGAN RD.
<br />CERES CA 95358
<br />CAL000393680
<br />; 44ar rj y Phone:
<br />ga 9b. U,S. DOT DosodpWn preluding Proper Shipping Name, Hazard Class, ID Number,
<br />10, Containers
<br />11. Total 12. Unit
<br />13. Waste Godes
<br />HM and Packing Group (f any))
<br />No. Type
<br />Quantity WiNol.
<br />1'NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL
<br />133
<br />SOLUTIONS)
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<br />1. Spaclat HapAiing instructions an4Add i'onai Information
<br />EMERGENCY CONTACT: CHEMTREC 1-800-424-9300 WOES TERN 'l!� \t.' * APPRORIATE PERSONAL PROTECTIVE EQUIPMENT*
<br />EMERGENCY CONTACT CHEMTREC 800 424 9300 *TRUCK
<br />A
<br />15, GENERATOR'SIOFFEROR'S CERT)F(CjATIONt I hereby declare that the contents of this consignment are fu„y and xrcQiraisiy dosgibo 1 AbUvo
<br />by the proper wpo pg memo, an7 sto d!asaso, packaged,
<br />marked and labeled/placarded, and are in all respects In proper condition for transport acrnrding to applicable international and national governmental regu'at rs> if oxpiA sit
<br />;am snt 7rd I am the Pfmary
<br />Exporter, I certify that the contents of this consignment conform to the terms of the attached
<br />EPA Ar n0ilkor,.oltt of Consent
<br />I crr iy chat the waslo minimization slatomenl idenlified in 40 GFR i62.27(o) (if I am z lo,;,a
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<br />16, I wr lonA Silipmants ##
<br />1 Import to U.S._
<br />Excsrt fruit U,S. Pori of entrytexir:
<br />Transporterslgriaiuro (for expors only}:
<br />Date leaving U,S.:
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<br />17.TmnspoderAcknowiedgmentofReceipt ofMW4:414
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<br />18, Discrepancy
<br />18a. Discrepancy Indication Space �~ Quantity ��! Type
<br />Residue
<br />1_ i Residue
<br />El Rejection
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<br />EI F0 Rejection
<br />Mani;osl P.efarance number:
<br />18t„ Al;ernatc Fac ily {a€Gars tlr)
<br />U.S: EPA ID Numb^_r
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<br />Fa* ry s Phone
<br />&1naHr Day Yeai.
<br />iR gra[.:ooht;ert€a'eFa':raty(ctGem!sator)
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<br />19. Hazardous Waste Report Management Method Codes (i.e., codes for lsa rMos waste treatment, disposal, and recycilng syslams)
<br />20. Designated Facility Owner or Op=_'rator Cer56catisn of receipt of hazardous materials cx vered ny the manifest s,; ruled m tt; u
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