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. i0r 4h:. G9,C <br /> Please print or type.(Form designed for use on elite(12-pitch)typewntec) Fonn Approved.OMB No.2050-0039 <br /> 1.Generator ID Number 2.P.m 1 of 7.Emergency Response Phone 4.Manifest Tracking Number <br /> UNIFORM HAZARDOUS enera005106368 JJ K <br /> WASTE MANIFEST C F, C 0 0 2 6 3 5 1 4 4 1 800 424-9300 <br /> 5.Gene ammFa mdbrrl9gCN Generators Site Address if different than mailing address) <br /> rC�(nN <br /> 425 N.EL DORADO ST, FL 3 701 &956 W.WEBER AVE <br /> STOCKTON CA 95202 STOCKTON CA 96203 <br /> Generators Phone: 630 878-6834 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 1 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 9.Designatedfadlity Name and Site Address U.S.EPA ID Number <br /> DEXNNOlKERDOON <br /> 20 NOORITH ALANEDA STREET <br /> CONIPTCA VM C A T 0 B 0 0 1 3 3 5 2 <br /> Facilitys Phorre' <br /> (310)537-T 100 <br /> 9, 9b.U.S.DOT Descriptim(including Proper Shipping Name,Hazard Class,ID None ber, 10.Containers 11.Tolal 12 Unit <br /> 17.Walla Codes <br /> HM and Paddng Group(if any)) Na. Type Ouamri WINd. <br /> 1. 223 <br /> 0 NON-RCRA HAZARDOUS WASTE,LIQUID (OILY WATER) - <br /> TT 3 G <br /> z 2 <br /> W <br /> 3. <br /> 4. <br /> 14.Speaal Handling InsWctions and Additional Infwmafion <br /> NAERG# 9B1 : 171 'PROFILE#9B1 : OILY WATER`APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> HB PROJECT# 60242Al2 PO#AO80102167 <br /> 15. GENE RATOR'SIOFFEROR'S CERTIFICATION: I hereby dedare that the contents of this consignment aro fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeleopplacarded,and are in all respects in proper condition for transport according to applicable intemationaf and rational governmental regulations.If export shipment and I am the Primary <br /> ner,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledg a of Consent <br /> I fy Nat he waste minimushon stzrament identified in 40 CFR 262.27(a)(d I am a large quantity general I (b)(if I am a sm II qu ,genemtm)is We. <br /> Gene t srORstore Print Name ®V.) sour —�.�--J Month Day Year <br /> m ✓\ !� V <br /> IntematlonalS ipme El Import b U.S. ❑E_xpodhom S. Pon OfNe1141qmt <br /> Z <br /> Transporter signature(for exports only): Date leaving U.S.'. <br /> K 17 Transporter Aduwaledgreent of Receipt of Materials <br /> W Signa Monty Day Year <br /> Transporter 1 PnntWyped Nam f <br /> a - 1/9,-- 1 6SI Of <br /> Z Timnsponef 2 Prinbecirryp6d Name Signature Monty Day Year <br /> C <br /> r <br /> ♦ 18.Oiscuepancy <br /> 18a.Disaepanry Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 78b.Allemale facllity(or GeneratoQ U.S.EPA W Number <br /> J <br /> V <br /> LL Facllitys Phone: - <br /> w 18c.Signature of Alternate Facility(or Generator) Monro Day Year <br /> Q <br /> Z <br /> 19.1-arallous Waste upon Management Method Cades(i.e.,miles for hazardous waste treatment,disposal,and reading systems) <br /> 3. 4. <br /> 0 <br /> 20.Designated Facifity Owner or Operator CeNfication of receipt of hazardous materials covered by the manifest except as noted in Item Ise <br /> 1 PontedRyped NameSignature - Month Day Year <br /> i G l A u/ l -era 1 117- GF <br /> EPA Form 8700-22(Rev. 5) Previous¢ itionsareobsoete. - GNATEDFACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 10473.0593 <br />