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Meese pimtor lypo, (Form de-signad for use on elite (12•pitdh) tYPO'4 itpY.) Form Approved . 01 No. 205G0039 <br /> UNIFORM HAZARDOUS . Generato:1D NuPmx-r 2. Page 1 of 3. Erwgency Response Phrmi) 4. ManlfeslTrafcklrtg Numt�re]rWASTE MANIFEST C tt. Q (y 2 ms's ? 6 tit L 1 i:C�QO) 4024-19300 t ? 3 tJ JJK <br /> , . . <br /> 5. Gens�atc s Name and Mailing Address Generator's u,te Address (if ditt rent than m.alatg address) <br /> JIFFY LUBE II t <br /> :Lr; l :L SFI (�fit 5( 56C�1 % i i 1 . 'o CES i lfii , MONTHLY PALLING <br /> W r EST ShL IiF1!'. 1l f T�} }1 <br /> Generaior'sPhone: 209 952-1662 Vf; J.' 11 <br /> 6< Trnsp,� d4I 1 Company ;Nam.:I EPA ID N mbar <br /> ASBURY ENVIRONMENTAL SERVICES I CAD- 0282 f `t 036 <br /> 7, Transporter 2 Company Name U.S. EPAID Number <br /> 8. Desli <br /> 'gnatea Facity Name and Stte Address UI EPA ID Number <br /> US ECOLOGY VERNON INC <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 CAD097030993 <br /> FaciJlysPhone: f323 27 " =1?�QQ <br /> ga. gb. U.S. DOT Description (inciuding Proper Shipping Name, Hazard Class, ID Number. 10. Containers 1t , Total 12, Unit 13. Waste Codes <br /> HPt and Packing Group (if any)) <br /> No, Quantity 4�itNol. <br /> 1 ' NON- RCRA HA7_ARDOUS WASTE , SOLID . �OIL.Y SOLIf�S-PAPER FILTERS} � 160 <br /> 352 <br /> I <br /> c9 ; <br /> i <br /> i <br /> 3. <br /> r <br /> 4- <br /> rvr 'r <br /> i-i: ap r al } t7nd'urginci xltasandAdiliLronaflnfgrmatiQnry <br /> EMERGENCY CONTACT : CHEMTREC 1-800-424-9300 tl OES TERMINAL: CERES CS NAERG# 9B1 : 171 PROi7w�0 <br /> 9 P <br /> 19227.0 OILY SOLIDS-PAPER FILTERS se P500-00051514 v° APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT )/ ' <br /> G <br /> 15 SFNFRAMR'S1r1FFFROR'R (TR11Fit:AlION : I heratmy dariare Ihet the co of th!s ca is'Gnmunl are Cully and au urateiv daseribed above k t Ume proper shaping Hama, ani are classified, packatged, <br /> marked and tabeladfplacarded, and are in all respects in proper conditlon for transport according to applicahie international and national governmental regulatia�s. if export shipment and I am III Primary <br /> Exporter, l certify that the contents of flus cr_nsigament conform to the terms of the attached EPAAcknovrledgmmnt of Consent. <br /> 1 certify that the viaste minunizatioi satement identified in 40 CFR262.`?7(a) (if tarn a targe quantity gene ater) or (b) (if i am e sroafi quanttygtxratoi) is true <br /> G r errt7 siol f�: rs Printudirypei Nape � S gtilk::u � Mouth C'a/ <br /> 4 J <br /> j t { <br /> 16. Werationai Shipment's <br /> Import to U.S. ❑ Expork from U.S. Pod of enuyfexit: . <br /> Transpoder s gnalure (for exports only): Date leaving U.5 <br /> w 17. Transporter AcknvAl ;dgmentofReceipt ofMaterials <br /> Tran<_pa mart PrinWiTyped Nara <br /> Signature Moms Day <br /> �� <br /> ILI <br /> Transporter 2 PrintedrTyped Name Signature Month Day Year <br /> I 'm pvr <br /> r— <br /> t 18 . Drscrepawir <br /> 18a. Drscre ncy incicaton space Quantity E Type u Residua <br /> r Parl2l Reledion !it ull Rejeet efi <br /> t;anifestRafareres~ Nmrrntti=r: <br /> 1m1.S. EPA ID Number <br /> l y a <br /> 0 <br /> uQ. Faciuy s Moe:LLj k;on?lm Day Ydrir <br /> (or Generatr:Ir) <br /> Q <br /> ` � _ <br /> N12, Hazardous x'a to Repo fi na;eman! 6 ''Cod Co&s (i-e., codes for hazard yus vraste l eatrne fl#o:•a?: and ra y ting sysems) <br /> LU 1 ,. 2. 4 <br /> 20. p srgrted F.,ci@ty.OKner or Operate. GenfraGotm of rare!pt or hazardous materals covered by the manifest except as rmdea in item 18a <br /> Pdnb dT))1iti fd; tr. sxs7 t1ur= Month Day Year <br /> Y � I <br /> FI3Fofin87!)G-Z2 (tey. 3-05) Previouseditionsareobsolete. DESII53NAT'EO FACILITY TO DESTINATION STATE (IF REQUIRED) <br />