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Form Approved. 0MI3 No, 2050-0039 <br /> Please i / p: omr designed for use on alile_E12'ptto 1.1fy -:rH2�J 2• Faga 1 of 3;Emert�ancy Response fill 4. M4nlfis[lracking 'Numbsr <br /> UNIFORM HAZARD 8 1 • GeneratorIDNumher { 8 � `� K <br /> WASTE MANIFEST C A L '.10 0 ; G G 5 _# (t 1 (E00} X121 93Eiii tJ � . O � � � �i +� � � � a � . <br /> '� �"QarrraicrsN2lnb. andl:iolh rddrass • Genu+atbdsSitsAddnss (1�"dlltarnt7han:rifaiNtq.eddrass}- <br /> 8 B TIRES & A 0 <br /> SERVICE <br /> �t9 N (. LUI`F AVE Sl'E 0 <br /> LOO! CF <br /> Generators ITT208 339-?916 _ .. <br /> Gr fletlspaSaKf Corripatr�/ plamei <br /> AA <br /> 17:5: �P;i : ambos <br /> tfft;!,Ei ORL t?iyiRONt/lEf JTAL SERVICES <br /> . : 0 2 A. 'l. . <br /> •7 ;T(ah;gorf��z C:arnp3ny ffa•'m?'. <br /> U.S. EPAID Number <br /> 8. Deslgnoted Fai Mame and Silo Address <br /> US ECOLOGY VERNON INC <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA ;:3005 & . C A D 0 9 7 0 3 0 J �3 3 <br /> FacllilysPhone: . (323 )277 .1500 - <br /> 1o,Containers 11 . Total 12, Unit: , 138 Waste Codes <br /> ga. gb. U:S�DOS Description (Including ProperShlppingName, Haid Cft;ss, ID Number . : .`: tVo. _ Type Quantity . WUVoI. <br /> I-IM and Packing Group (deny)) _ ' ` r : ' <br /> 1NON4BORA HAzAROOUS WASTE , .OLID ( BRAKE IA TFIESHAVINGS) 61 <br /> 7o c� PFl! IF . <br /> dd <br /> ITT <br /> TUILY <br /> i - <br /> DEPARTMENT <br /> ! <br /> 4.•S ; cfaf3ld! 9, . sit'. nd�d<fils (dnlnfma�oii - - <br /> EMERGENCY CONTACT ; CHEMTREC 1-800-424-9300 WOES TERMINAL: * PROFILE # 961 : 09172013.0-1 BRAlr,l LAIW � <br /> ITT <br /> SHAVINGS '� P500-00063085 ' APPROPRIATE PPE EQUIPMENT = <br /> 2 lx - <br /> -_ - <br /> 16, " OENERA70R'SIOFFEROft'S CERTIFICATION: t fi ire5y de'dfara 8tafihe tonletits of Sits conslgriinent are fully and accrralely'nsedbed-above by 1116 pfdper sldpplrig we, ard'are tdessl8ed, pec ge , <br /> in and labeledfplaraidad, and are in all respects In proper condition fortransport according to applicable international arta national governmental regulations. If export sNpment and I am the Primary t <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. Is true, <br /> It • • N If I am a large guanlity generator) or (b} $Gam a small' uut7litycgerl re1¢f} _ <br /> f ,r 'ythatInawasteminkntza1lonstatementIdentifiedIn40CFRi20;17(6):( Ronga pad_ yoit :. <br /> >xd 4e. <br /> ns tarscottsrd il. . t ?Yp TV - <br /> ante <br /> L . - — - <br /> ••. <br /> _ 1 6. Intema8onal Shipments ' ❑ import to U.S, ❑ Export from U S Port of enlrylexit: - <br /> Transporter signature (tot exports ody): Date leaving,U.S,: _ <br /> W 17. TranspoderAoknw+ledgmenlofRecelptofMaterials _ <br /> Trmtsrt� 'nJ9dlpjp 'Mattie: _ <br /> S tdgnl Rey; Yeat ' <br /> r j <br /> jW UF77 77TIVITTI <br /> •: . "�1.- - _ • • ,' _ * V <br /> ITT <br /> _ Month Day Year <br /> Transporter2 Pan ted ype Signature <br /> }- ' - - - <br /> iiiiiiiiha <br /> 18. Dlacrep'ancy .. . . ... . _ .. .. ... . _ . . - . . . <br /> 18a, Dlscrapincy Ind! aQDo Space ❑ QuanWy - ..❑type ❑ Residue <br /> ❑ Parfro! Rejection ❑ Full Refection <br /> r <br /> Metllfd a�sie ' te' tf[h>iai _ <br /> 1b1 ±Alfetnd(e:i acedy dr:Gna. : J . . IT <br /> u FelUlk¢Phot`tesr Month pay Year ' <br /> 18c Signature ofITT <br /> IMMUNE I <br /> Ilemale Faaility'(or Generator) <br /> rf _ - <br /> ,c r . <br /> •T <br /> jiTV <br /> jyyJ ;hyotiign'ggeaiuriTMethod Codes (i.e., codes for hazardous waste treatment, dtsposai, and recycling systems) 4 <br /> Vill <br /> 20.bes�na(ed Facyity Os ero[ Operator-Certificallon of recelp( of hazardous materiels covared by the manifest except as noted in Item 18a - <br /> _ . . <br /> plh . Day' Yeiri <br /> -Lita}. � <br /> EPA Form 8708�2_(Rtt'L 3.,`85) F M j)a-,ddlh.¢,i)9 are o4sufale; <br /> - - -- TRANSPORTERS COPY <br />