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Please (it it r;: (-aim? designed for use on slile_F12 Pil i),,ty . .)` <br /> Eomt 3pProvedr OMB No. 2050-0039 <br /> UNIFORM HAZARD I t • Generator ID Number 2. Paga 1 of 3;EmergancyResponse Phono d. M{rtylfi9}tTropacklCCng+K�umbsrA '`� *� <br /> WASTE MANIFEST C A L t t U 0 3 6 G ! 0 CI ? (300) 42=1-`. -5 i J ,I . L) J G +� L. � � . - <br /> 5 Qerviralbt'sA2ttrm.and'tdn0h(y! 1!ddress. Generatbds5rloAddras„ (16di1(arnllhvr:rifafNiq.rddtes3) <br /> € $ 5 TIRE 5 2r tU.TO SE- RViGF <br /> 39 N (: ll AVE STE t) L 521 <br /> LOU GF. .r.j 10 <br /> Generator's Phone: 209 339 =9 <br /> GcTtgns rufar:fiGartipay. Ilag)e; r{ ' ` <br /> � rl r i.r �iL E�fyiRONr%tENTALsEr�VICES WIN <br /> - <br /> _ . . - <br /> - <br /> u ^01 Val Rm � n�r: : : . .. <br /> t�ahSizsiar z gbm00fltfafne. <br /> _ - <br /> US E <br /> PAID Number <br /> 8. Deslg ,Died Fal Name and Silo Address <br /> US ECOLOGY VERNON INC <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES <br /> CA, c90058 . , ADO 9 7 0 3 0 9 9 <br /> FaellilysPhone: . (323)277 -1500 . . - <br /> .. .1od- nlalners 11 . Total 12. 1l , g3, Waste Codes <br /> Ram gb. U.S DOS Descriptbn (inclurting Proper shipping Name, Hazard Class, (l).Num6er, : .': . : . Type : quantt VYtNoI: <br /> and Packing Group (if any)) <br /> No, a ty . <br /> HMntl _ <br /> 1p <br /> 1NON4RCRA HAZARDOUS WASTE , SOLID. ( PRAKE1.ATfIESHAVINGS) <br /> a t <br /> a ! !o P <br /> PFF <br /> - <br /> - <br /> DEPARTMENT <br /> t4, •S : itdE{ft t ::sl�tict:. . . nd�iRiiisal,)libfinaoii $ <br /> EMERGENCY CONTACT : CHENITREG 1-x00.4249300 WOES TERMINAL: <br /> * PRC}FiLE # 9S1 : 09172013 0.1 I3RA14E l �T�l� <br /> SHAVINGS P500-00063065 * APPROPRIATE PPE EQUIPMENT <br /> 16, GENERATOR'S(OFFEROR'SCERTI�ICATION: i fieretiy decfaro Ihatihe contents of this consignment are fully and accuialefy'f�sedbel above by the proper ehfppbig' name, aM ere Classl8ed, packaged, <br /> marked and labefedlplacarded, and are in all respecls in proper condltlon for transport according to applicable Internet anal and national governmental regulations. if export shipment and [ am the Primary <br /> Exporter, I ceAlry that the contents of ififs consignment conform to the terms of the attached EPAAcknowledgmant of Consanl, Is hue, <br /> that tfie waste minipdzation statement in 40 GFR*204,t7(4):(If I am a large quantity generator) or (b) ff(:am a sural{ �juprrbly9ed C1d Vit). .. _ <br /> FSerN�y Tdanih Rai' Yat : <br /> lie ' tsi?sFOltcf l#rieje+ ah <br /> • <br /> ...I S. International Shipments• - - Q Import fa U.S, ❑ Export from U S Pori of entryfex{t: <br /> Data leav{ng U.S.: <br /> Traneporler signature (for exports ody); -- • - - -- " ' - ` <br /> ti 17. 7ransporlerAcRnowledgmeriloflieceiptofMatedals <br /> 4009 <br /> Trmss dr nt9d111p . :tiialfte: <br /> • s>�mtu ;. tdggl.:'. Rey; Y�ttr ; <br /> V <br /> ' :. <br /> Month Day Year <br /> -19 Transporter2 Printed ype Signature <br /> 18a, t)iscrepancy Indication pa ❑ Residue El Partial Rejection ❑ Full Rejection <br /> Q Quantity :Typa <br /> Iann�s� Rat��p ' ce uri, r — <br /> tir6:�AIt��N�tur . <br /> ,1b1?!rfettfp, :l aciTd bC . nar ) : <br /> dl <br /> u FaJlilyphprTe.; - Month Day" Year ' <br /> y feK Signature o : lemats Faclgty'(or Generator <br /> +a yam. <br /> .� r . <br /> Will <br /> Will <br /> ;jp,}j 0. 014P iirt Sgn�geirjsnTMeihod Codes (I.a codes for hazardous waste treatment disposal, and recycling systems) q <br /> 20. Desfgriated Facyity lh eror dpAralor' Cerfific2liari of recelpl of hazardous materials covered by the manifest except as noted In Ilem i8a - <br /> ero pointers <br /> Pririi . . partavarne. 1 <br /> Ilinnatura Oth : ()' Ycgt <br /> ILL <br /> } <br /> T-pAINSPORTEt t S COPY <br /> EPA Form 8700lL'22_(Rb'1, ;$?4$) tiyub are:o4sow0f <br />