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DTSC. 03248 .0237 <br /> Please print or type.(Form designed for use on elite(12-pitch) writer. <br /> 9 ( P )A'Pe ) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2,Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST A 0 3 1 (HU01 424-W;JUU 014 0 518 9 7 JJ K <br /> 5.Generator's Name and Mailing Address Generator's Site Address If different Gran mailing address) <br /> TRACY CHEVROLET--Q&M INC <br /> 3400 AUTO PLAZA AY <br /> TRAC`f CA 96304 <br /> Generators Phone: 209 935 400 <br /> 6.Transporter 1 Company Name U,S.EPA ID Number <br /> A,55M E14032NIA I44EBVIQU a o Q a Q <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> EVOSUA WATER TECHNOLOGIES LLC <br /> 537 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 C A D O D 7 0 3 0 9 8 3 <br /> Facility's Phone: ('2132)977-4 Finn <br /> 98 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Contai 11.Total <br /> 13.Waste Codes <br /> HM and Padang Group(if any)) . No, Quantity <br /> 1, <br /> o NON-RCRA HAZARDOUS WASTE,SOLID(BRAKE LATHEUj <br /> Uj SHAVINGS) f fc� % <br /> Z 2. <br /> w <br /> t� <br /> 3. <br /> 4. <br /> t. <br /> 14.Spedal Handling Instructions and Additional Information <br /> EMERGENCY CONTACT- CHEMTREC D 0�W NAERG#9B1! 171 + PROFILE #9B1 AP190186 BRAKE <br /> LATHE SHAVINGS A POP A110204019 :APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and a ly bed above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are In all respects In proper condition for transport according to applicable Intama eland nado I govemmentel regulations,If export shipment and I em the PrimaryExporter,I cerdy that the contents of this consignment conform to the terms of the attached EPAAclmowledgment of sent. <br /> I certify that the waste minimization statement Identified In 40 CFR 282.27(a)(If I am a large quantity generator)or(b 81 em a s I quantity generator)Is true. <br /> GeneratceslOfremr's Print d(Typed Name Signature Month Day Year <br /> —1 116.International Shipments <br /> ❑Import to U.S. El Export fro Port of entrylaxlt: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Transpo 1 Printed/Typed Nam Signature Month Day Year <br /> Z rensporter 2 Printed/Typed Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑ResidueEl j j <br /> Partial Rejection Full Rejection <br /> Manifest Reference Number. <br /> 18b.Atemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> L& FadliVs Phone: <br /> W 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. . <br /> fi( (�/ I <br /> 2 3. 4. <br /> 20.Designated Facility Owner or Operator Certification of receipt of h ardous material Bred by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previ us 4ditlons are obsolete. DESIGNATED FACILITY TO DES IN TION STATE(IF REQUIRED) <br /> 12004.2107 <br />