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DISC. 02D3*i.. IV Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Trackin Number WASTE MANIFEST 11(800)424-9300 013 0 T 6 7 6 0 JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) I RM�n41nr.,nV LG 1'A 0.im N►INC - TTRRACY UTO PLANA V1 AY CA 96304 Generator's Phone: 209 L335-4500 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 ompanyame U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number EVOQUA WATER TECHNOLOGIES LLC 5375 SOUTH BOYLE AVENUE LOS ANGELES CA 90059 Facility's Phone: CAD 0 9 7 0 3 0 9 9 3 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit Q.Waste Codes HM and Packing Group(if any)) No. T Quantity Wt.Nol. 1. o NON-RCRA HAZARDOUS WASTE,SOLID (BRAKE LATHE SHAVINGS) 1 D /V� P Z 2. W 3. 4. 14.Special Handling Instructions and Additional Information FMFRGFNP_.Y CONIAC.T; C-HFMTRFr 1-RC J-A7aA'gM N9ERrq#E031:171 + PR(1- II F 9 901 AP190186 BRARE LATHE SHAVINGS * PO#Ai10189949* A �OP ATE PERS yfiL FIROT EQUIPMENT 15. GEN ERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and e y descn above by the proper shipping name,and are classified,packaged, marked and labeled/placarded.and are in all respects in proper condition for transport according to applicable inte onal and national go mmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmen of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)o b)(if I am a small qu .ty generator)is true. GeneraOffer is Pnted/T ped Na Signature Month Day Year C L�, a 16.International Shipments F- ❑Import to U.S. ❑Exportfrom U.S. Port of entry Transporter signature(for exports only): Date leaving U.S.: IX 17.Transporter Acknowledgment of Receipt of Materials � Trans r 1 PrintedlT Signature Month Day Year a . y Z Transporter 2 Pdnted/Typed filame gnature Month Day Year tr H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residuej j ❑Partial Re action Full Rejection Manifest Reference Number. 18b.Alternate Fadlity(or Generator) U.S.EPA ID Number J U LL Faciliys Phone: W 18c.Signature of Altemate Facility(or Generator) Month Day Year Q Z H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and reading systems) 0 1. I L+ 2. 3. 4. 20.Designated Facility Owner or Ope tor.Certification of receipt of hazy us mate4s co ed by the manifest except as noted in Item 18 Pdnted7Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) VrFOus editions are obsolete. DESIGNATED FACILITY TO DES INATION STATE(IF REbU(RED) 11814.1977