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. . <br /> , <br /> Please print a type.(Form designed for use on elite(12-pitch)typewrite.) - Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergwwy Response Plane 4.Manifest Tracking Number <br /> WASTE MANIFEST r A D 9 8 2 3 6 5 9 4 1 1 009573266 JJ K <br /> 5.Generators Name and MI Address Generators Site Address,If different than mining address) <br /> N1A`AMCRANE WORKS <br /> PO BOX 999 2373 MARIPOSA ROAD <br /> LA PORTE TX 77572 TOCKTON OA 952M <br /> Generators Phone: 916 452-3981 �p <br /> 6.Transporter 1 company Nems U.B.EPA ID Number <br /> ASBURY ENVIRONIVENTAL SERVICESCAD 0 2 8 2 7 7 0 3 5 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number �> <br /> SIENENS INDUSTRY, INC. <br /> 5375-SOUTH BOYLEAVENUE.. _.. ....— ----- -- ._.. .. <br /> .. . ........... . <br /> LOS ANGELES CA 90058 C A D 0 9 1 0 3 0 9 9 3 <br /> Fe Phone: 03231277-1500 <br /> ga go.U.S.DOT Description QndUdli Proper Shipping Name,Hazwd Class,ID Numbem, 10.Contoinem 11.Total 12.Unit 13Wave car n ' <br /> HM end Pacldrnp Group(ffatM) No. Type Quantity WtNDL j <br /> NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLIDS] Z0 DA 606 o <br /> Z 2 <br /> w <br /> CJ <br /> rrip4: <br /> 3 <br /> I' <br /> ip <br /> 4. C <br /> r <br /> *%—Walliandifing lnelruc9orneand Addillonallnfom,etion <br /> ENERGENCYCONTACT: CH_MiREC 1-SO0.42d-9FiQONAERG#981 : 171 'PRORLE#9B1 :AP4b11Sg0iLYSWIiD!, <br /> ABSORBENT,SWEEP'PO#A110151163'APPROPRIATEPERSONALPROF'ECfiIEEOUIP T gir Y <br /> I: <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby declare that the convents of this consignment are fully and accurately described above by the proper shipping name;and are dassfled,yackaged, <br /> marked and labeled/placarded,and are in al respects In proper condNon for transport according to applicable Intemaborai and national governments!regulations.If export shipment and I amths Primary <br /> Exporter,I catty that the contents of this consignment conform to the terms of the warmed EPAAcknoWedgmeM of Consent. <br /> 1 cw*drat the waste rrinlmtratlon sfatementkartlfied in 40 CFR 262.27(a)it I am a large quan'hy genwato(or(b)(if I am a smal quantity generals)is true. <br /> rere wofferors Pdnted/Typa come Bi lure Days Y9 ' f <br /> JO <br /> .� 16.International Shtpments <br /> p- ❑Import to U.S. ❑Export ftwn U.S. Pat of antrylexit _ <br /> Transporter signature(fix exports only): Dare leaving U.S <br /> w 17.Transporter Acknowledgment of Receipt of Malenals <br /> T w 1 Pdnted(TY d Name SlgnaN n Da Year <br /> L <br /> ah <br /> za Transporter 2 Pnme(20 Name Sgnahre Month Day Year <br /> 1B.Disompancy <br /> fila Disunpancy Indication Space ❑ Quantity ❑TYPe ❑Residue ❑Partial Rejach. ❑Full Rejection <br /> Manifest Reference Number: - <br /> 7 <br /> 18b.Plkmate Facility(or Generate) U.S.EPA ID Number <br /> U <br /> LL Faclf4ys Phare: <br /> W 18c.*nature of Alternate Fe (a Genemto Month Day Year <br /> 8 <br /> Hazardous W ste Report Management Method Coda(IA.,codes for hazardous waste treatment,disposal,and recycling systema) <br /> 0 1. 2 3. 4. <br /> 20.Designated tity r or Qpar .tor.Codification of recelpt of h twlals covered by IAe manifest except as noted in Item 18a j <br /> 1 Pry typed Nam SgnamreMoaN Day Veer <br /> FPA Form 8700-22(Rev.3-05) _PilevIIed ma are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />