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...........--,.............. <br /> Please print or type.(Form designed for use on elite typowriter.) Form Approved.OMB No.2050-0039 <br /> I <br /> 4.ManifestTraddrig Number <br /> UNIFORM HAZARDOUS 1.Genamw ID Nurn4ar 7.Page l.of 3,Emorj',n4Response-PharT. <br /> WASTE MANIFEST CAL 000341179 1 (800)4249300O I 1 1 014053016JJK <br /> -5.Gen-arato(s.14ame and ManfrigAddress: <br /> WESTERN TRUCK CENTER <br /> 3333 S.HWY 99 <br /> STOCKTON - CA 95215 3333&HIGHWAY 99 <br /> `Genenaloes Phone: 209 323-7300 STOCKTON CA 95211 <br /> '6.Tranzpoqqr1 CompinrName U.S-EPATI)iNumbor <br /> ASSDRYENVIRONMENTAL SERVICES CAD 0282'77036 <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> B.Designalad For4ly Name a11d1SR4,Addr--5$ U.S..EPA 10 Number <br /> EVOQUA WATER TECHNOLOGIES LLC <br /> 5375 SOUTH BOYLE AVENUE <br /> Los ANGELES CA 90059. CAD 097030993 <br /> Fac!R,j's Phone: (323)277-1500 <br /> 9a. 9b.U.S.DOT Description(ificluding Proper shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.W;W,Codes <br /> Hy and Packing Group(If any)) No. Type, Quantity WLNOI. <br /> Ce 1- NON-RGRA HAZARDOUS WASTE,SOLID(DIESEL FILTER 352 <br /> 0 - I I <br /> F- PARTICULATES) DN A F) P <br /> 0 <br /> ca i <br /> 3. <br /> Z <br /> Uj <br /> 4:. <br /> 14-Special Hand1iN,IrzbucUQns and Aedreorad.1rilermdon <br /> EMERGENCY CONTACT.:CHEMTREC 1-800-424-9300 NAERG#9131:171*PROFILE#981:050816-2 DIESEL FILTER 0 CNIL <br /> PARTICULATES APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT IXS,,,- <br /> r\A, <br /> 15. GENERATOR'SIOFFEROFUS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are'rla5sffied;packaged; <br /> marked and labelaplacarded,end are In,all respects In proper condition for transport according to appilcable International and national governmental regulations: experishfpmentand-larnihoPrimory'' <br /> * _ <br /> Exporter,f certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmenit of Consent. <br /> I cer1enfiried in-40 CFR 262.24a)(if lam-a large quantity-generaor(b)(if am a small quantity goner 9 <br /> y that the waste minimization statement L <br /> enera r's Nnto.dff.yP__PeJ'Name anature Month Dey.". Year <br /> t5,int rc ailonalShipmant5. Gy�11 <br /> 0 Import b U.S. ❑Export from U.S. Port of en <br /> Transportersigm.ture jfbrP-xporLqoatyr. Date leaving U.S.: <br /> LU17.TranspofterAcknowledgMEnt of Receipt of Materials <br /> Trannpo 1 FfmIad. ypM =,a Signature <br /> MoMh` Day -Year <br /> 0 <br /> CL <br /> Transporter 2 Pririledfryped Nam, e mmth, Day Yeao. <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection Full Rejection <br /> Manifest Warence Number. <br /> 18h.Ailernato Facility(or Generator) U,S.EPA 113 Number <br /> Facility's Phone: <br /> LU 18c.5xnawraafAftemate Far4ity(or Genemlor) Month 'Day Year <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(Le,,codes for hazardous waste treatment,disposal,and recycling systems) <br /> ul <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest exceptas noted In Item 183 <br /> Printectfl`yped Narnm smature fuiorah pay Ir <br /> EPA F=8700-2?(Rev.3-05 PwAous editions are obsolete. DESIGNATED FILL`TO DESTINATION STATE(IF REQUIRED) <br />