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e <br />r <br />Please nrinl or lvoe.(Form designed for use on elite[12-oNchl hnewriterI h^.t': Form Aooroved. OMB No. 2050-0039 <br />STATE (IF REQUIRED <br />UNIFORM HAZARDOUS 1. Geneat"IDNumber <br />12. Pagel of <br />I 3.Emergencp Respon'sePhone <br />4. anlest <br />ao n Number <br />yWASTE MANIFEST CAD 0 2 9 4 9 5 0 7 4 <br />1 <br />(SOp) 4249300 <br />1 b <br />5809 JJ K <br />5. Generators Name and MalingAddrese Generators Site Address (ddifferent than mailing address) <br />SIMS HUGO NEU - STOCKTON <br />i000 S. AURORA ST 1000 S. AURORA ST <br />STOCKTON CA 95208 STOCKTON CA ' ' 9(5208 <br />Gamuata's Phone: 209 948-4000 t <br />6. Trampaler 1 Company Name n U.S. EPA ID Number <br />ASBURY ENVIRONMENTAL SERVICES 1CAD028277036 <br />7. Transporter Company Name -" U.S. EPA ID Number <br />8. Designaled FadIty Name and Site Address U.S. EPA ID Number <br />DEMENNO/THKERDOON <br />2000 NOR ALAMEDA STREET <br />COMPTON CA 90222 <br />FacTmy's Phoma:. (3101$37-7i00 CAT 0 8 0 0 13 3 5 2 <br />gra <br />_9b.U.S. DOT Descriptim(ndudog PmW Shipping Name, Harard Class, ID Number, <br />1D. ConwYiers <br />11. Total <br />I <br />12, Unit 13. Waste Codes <br />No. <br />Type <br />HM <br />-and Padding Group(ifany)) <br />Guan6ly <br />WL". <br />c <br />t' NON -RCRA KVARDOUS WASTE, LIQUID (OILY WATER) <br />00i <br />TT <br />G 20 <br />, <br />a4 <br />R <br />' l <br />3 <br />UG <br />JROWAi <br />Tun caarn n1r <br />)p <br />14 Special..( shuctiats .... rtaMn kr - .: ,- :, + r n ...i s fa t"sq ,. <br />,.A-n,`t4" .'Xedt. 'ww+i*i5..-n aT��. n.<1 r'es au.n.!^;'s r Mduz>x.z�+a4+i'�'-, : z;, <br />'PROFILE *EERGENCY ¢� <br />q BBi! # 981, -ACP CONTACT. CHEMTREC i' 900 429300 <br />AUTOMOTIVEC'LARIHER PROQ4;k4M ** * ADDITIONAL EPA CODES: 0i:, NONE * APPROPRIATE PERSONAE <br />i <br />PROTECTIVE EQUIPMENT - ` I-t-t*/to ZZ ))UJ7!j LA 2-Aa 141ARCF7 r <br />- 15. GENERATOR'SIOFFEROWSCERTFICATION: Ilhnebydedaa that the comentaof0ds wnsignnhenl ae hAyaM acvawly described above by the proper shgp4g name,aM are 4pacvaged, <br />maked and labeledlplamtded. and Bain anaspects in phopamoditiah for bwVMacc ditfoappkahleintema6ah wW national shipnhemand In thelyrimane <br />Exporter, l asely that the conwms of Bdsmmgmtmlcon(amto the (arms ofthe abdted ERAAdmwIedFwd ofCatsenL <br />Icertifylhmtho Naslembbiza6ms dUuMMin40CFR26227(a)(dlamalagequamdygmuaMm(h)(dlama smanquanbTygenecator)isbue. <br />GeneabrsWe Ws PdntM?yped Name signs nth Day Year <br />L <br />J <br />F <br />al SNpts <br />18. hdefiarw <br />ma❑Impalw U.S. ❑5yorl ban U.S. PMbfenbywat <br />Tansporter.signaturs (for ebpods Dory): Dale waft U.S.: <br />w <br />17. To" AdnuiodgrtpNofReceipt ofMala'ials <br />Transporter l PnmMrTypM No / Signetina Momh Day Year <br />/3, <br />a <br />r �ct3 ©/ /0 <br />M <br />Tanspalor 2 PMtecUTyped Name Signabue Monty Day Year <br />F <br />Disoepasy <br />T18. <br />18a. Discrepancy Indication Space El omoidy ❑T" EI Residue ❑Parfait Roazon L1 Fun Rej d. <br />Manifasl Reference Number. <br />l6b.ANemate Facility (or Generator) U.S. EPA ID Number <br />J <br />. <br />U <br />LL <br />FacTitys Phone; <br />HVic. <br />Signature of Alternate Facility (or Generator) <br />Month Day Year <br />Q <br />r <br />2 <br />19. Hazardous Waste Report ManaganeM Method Codes 0.e., codes far hmnlous wase bea6nem. disposal, aM recycling sysiam) <br />o <br />ti <br />2. 3. <br />4. =' <br />20. Designated Facility Owner or Operator. Certification of recelpl of hazardous malMms oovemd by the manifestezcept as nded in Item lan <br />Phbdedrfyped Name -. Signature ' Month Dar Year. <br />EPA <br />Forth 8700-22[Rav M51 PreVmue editions are Mantels. <br />STATE (IF REQUIRED <br />