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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 Tracking Number WASTE MANIFEST ; 0 ,j L) -15 , .1 i5tr 017 4 6 7 4 6 JJ K 5. Generator's Name and Mailing Address Generators Site Address (if different than mailing address) U '1,A iV1 <`•i OR:3. CON"i - t..?SA03' 0 13 100018E AVE itt+.68*HROP ,A 73 ' 0 Generator's Phone: 209 983- 8888 6. Transporter 1 Company Name U.S. EPA ID Number WORLD OIL ENVIRONMENTAL SERVICES CAD 0 2 1 2 7 +0 U 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number US ECOLOGY VERNON INC 5375 SOUTH BOYLE AVENUE LOS ANGELES CA 90058 Facility s Phone: / 4 -1 rnn 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 t.tal 12Unit HM and Packing Group (if any)) No. Type Qua 11 . Total 12 . Uni 13, Waste Codes 0 1NON- RCRA HAZARDOUS WASTE, SOLID ( BRAKE LATHE SHAVINGS ) � r ($ 2wm�d P -- z 2. LU 3. 4. 14. Special Handling Instructions and Additional information EMERGENCY CONTACT : CHEMTREC :1-800424-9300 WOES TERMINAL: * PROFILE # 961 : 604764 BRAKE LATHE SHAVINGS * P500-0006.5228 * APPROPRIATE PPE EQUIPMENT F e7 7� 15. GENERATOR'SIOFFERO1%. TIFICATION: I hereby declare that the contents of this consignment are fully and accurately described 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 international and national governmental 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 EPAAcknowledgment 'of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. ener, (s/Offerors Printed/Typed Name (gnat(g Month Day Year - i 16, interna tiipments - - - 6 ((fL F- 6 ❑ Import to U.S, LJ Export from U.S. Port of entry/exit: Z Transporter signature (for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials Transpo rintedfTyped ame Signature Month Day Year O a l Z Transporter 2 PrintedlTyped Name - Signature - - Month Day Year - 1- 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number. H 18b. Alternate Facility (or Generator) U.S. EPA ID Number _J V W Facility's Phone: w 18c. Signature of Altemate Facility (or Generator) Month Day Year Q Z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) LLJ 0 1 . 2• 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a Printedffyped Name Signature Month Day Year EPA Form 8700 22 (Rev. 3-05) Previous editions are obsolete. , DESIGNATED FACILITY TO DESTINATION STATE (1F REQUIRED)