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016774134JJK <br /> Please Print or type.[Form des for use on elite 12-pilo)typewriter.} <br /> UNIFORM HAZARDOUS ' Generator M Nunffisr 2.Page 1 ar 3 kmargenq Ras Form All OMB No.20%-0039 <br /> sponse Phone 4-Maryrynlfgqasl TraeYl7nO Num r r <br /> WASTE MANIFEST CAL 0 0 0 3 71 716 ] (a0oy 4249900 V l f 3 4 VJ K <br /> 5-C>Eixxalars Narrre and&V ilAddresa Ccrwralors 5ilcAddresy(if dilFerent than nraHrnq address] <br /> PAUL RLANCOS GOOD CAR COMPANY <br /> 3190 AUTO CENTER Of <br /> STOCKTON CA 95212 <br /> Generator`s Prxxre: 916 928-4460 <br /> Trao&panor t Crmlpany Namo <br /> ASBURY ENVIRONMENTAL SERVICES u.s.�ArOluumt�r <br /> T.rrenspuler z Camisany Hama CAD028277036 <br /> U.S-F.PA IR hkrmbcr <br /> 8.Des� ed Fadbry Name and Site Address <br /> US ECOLOGY VERNON INC U.S.EPA ID Number <br /> 5375 SOUTH BOYLE AVENUE <br /> Los ANGELES CA 900558 <br /> FF* sPhnnd. CAD097030993 <br /> 9a. 96.U.S[IOP Desrxlpl{on(including Proper Shipping Name.Hal Class,ID Number, 1D.contain I's HM and Pardung Group(A arryj) 11,Total 12.Unit 13.Waste Codes <br /> 1 No, Type Quantity Wi <br /> v NON-RCRA HAZARDOUS WASTE.SOLID(BRAKE LATHE SHAVINGS) <br /> 1t]F iso <br /> z 1 Q) p <br /> i <br /> f 4.Sycvla£karrdtng InsWdlpr}s and Addi6onai InfonneKxr <br /> EMERGENCY CONTACT:CHEMTREC 1-800.4249300 NAERG#9B1 t 171 *PROFILE 0 981:APi92387 BRAKE SHAVINGS <br /> PS00.000434$8*APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> Zg ! SCS 31oi�r/ <br /> 15. GENERATUR"SA7FFEROR'S CFATIFr—AT1GN:I hereby declare that the contents of this consignment are fully and&=xal desctihad above by the Prow dripping name,and are dassified,packaged, <br /> marked aril IebekdrPfawrded,and are in all respects In Proper eland tion for transport aocdrdrng to applicable Intarrratlbnaf and national govenvnental regulations.Ifavott <br /> Exporter,t MW that the contents of this consignment conform to the terms of the attached EPA"x*dadgmonl rA Consent. shipment and I am the Primary <br /> I cer8ty t the waste minimization statement 1410 ed in 40 CFR 2127(a)(d I am a large quanuty gonamtor)or(h)(AI OM a small quantity gQMrater)is true. <br /> �s PrinpadlT <br /> 1 SK or10tt Dar` air <br /> 1 lienal 'prnents �--rr + . <br /> u Import to U.S. O Export from Port of enlrylexit: . <br /> Tranatrorlarelgrlalure(hlrexportauray]! <br /> 17.T-SPOEW A*o4edl imiA of Racellof Materials Dateiea/KrgU-S.: <br /> T rtar 1 i ' Namc <br /> a 5ignabtro Month Day Yuar <br /> lranaportor yped ame L <br /> Srgrlahrre Month Day Year <br /> 18.Disuopanry <br /> 1Ba.Dtsmepancy Indi Space Quantity ❑Type L1 Residue ❑Pazlief ReJedfoh ❑Pull Refection <br /> 16b.A1rermte FacrTty,(or Generator) Mnrrlkwt Referenc6 Nrun <br /> us,EPAI11 Nunlbar <br /> LL Fatality's Phone: <br /> .Pr "wall Allemaw faGlHy(or ratgt] <br /> Montlr Day Year <br /> w14.Henrdpa Waste Repot Management Method Codes(la-.codes far hazardous waste bastmanl dand lspasal, i <br /> G 1. 2. "ng a7'stemsl <br /> 3 4. <br /> 20.kdrr mood FersYty Ovrner w GPer Certification of sgripl of hazardous materials covered <br /> Pnrrledlfyppd Namb by the manNest exr+epl as rrdsd in Item 1 Be <br /> slgnahrce Marlh <br /> FPA Faryn 87a(F2Z[Rev.3-05)Previous etAtions are syhsalate. <br /> DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />