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:ase print or type. (Form designed for use on elite (12 -pitch) typewriter.) <br />UNWORM HAZARDOUS 1. Generator ID Number <br />WASTE MANIFEST C A R 0 0 0 0 7 3 5 8 5 <br />5. Generators Name and Mailing Address <br />TRACY TOYOTA - TRAD78 <br />28% NORTH NAGLEE ROAD <br />TRACY CA 96376 <br />Generators Phone: 208 634-1111 <br />6, Transporter 1 Company Name <br />ASBURY ENWRONNENTAL SERVICES <br />7 Transporter 2 Companv Name <br />1 of 13. Emergency Response <br />800) 424-9300 <br />Generators Site Address <br />Form Approved. OMB No. 26500039 <br />Manifaat Tracking Number <br />008823080 JJK <br />ing ) <br />U.S. EPA ID Num1w <br />C A D 0 2 8 2 7 7 0 3 6 <br />8, Designated Facility Name and Stle Address U.S. EPA ID Number <br />5375 NTECHNOLOGIES CORP. <br />SOUTH BOYLE AVENUE <br />CAD 0 9 7 0 3 0 9 9 3 <br />LOS ANGELES CA <br />CA 90058 <br />Facility's Phone. 01277" 1500 <br />ga 9b. U.S. DOT Desmplm (including Proper Shipping Name, Ratard Class, ID Number, 10. coni ahers 11. Total 12 Unit 13. Waste Codes <br />HM and Packing Group fif any)) No. Type Quantity WtNd. <br />1. <br />3 NON•RCRA HAZARDOUS WASTE, SOLI D (BRAKE LATHE SHAVINGS) DM 3QO P <br />3. <br />3 <br />1a Special dandling Instructions and Adcritionai Information <br />GGSl'2I` <br />LA <br />SHAVINGS " PO# Al136727APPROPRIATE PERSONAL PROTECTIVEEOUIPNENT oVI %2i��`HE <br />.D 1,6 <br />15. GENERATOR'SiOFFEROR'S CERTECATION: I hereby derdare that the contents of this c onsignmont are fully and acarately described above by the proper shipping name, and are classified, packaged, <br />marked and laheledlplacarded, and are in all respects in proper condition ler transport according to applicable international and national governmental regulations. K export shipment and I am the Primary <br />Exporter, I ceerry Orel the contents of this consignment cunfam to the terms of the aftached EPA Acknowledgment of Consent. <br />car -- � —11 ..,—fit, --d-1 m rn is <br />GeneratorJORerors Priniedriyped Name - -- - Signature <br />nth <br />Day Year <br />Z2 1 <br />—1 16. Intemadonal Shipments Podof en k" <br />D Import to U.S. Export from U.S try — <br />— <br />— <br />1 Transporter signature (for exports only): Date leaving U.S.: <br />1W 17- Transputer Acknowterlgment d Receipt of Materiels <br />Signature <br />Month <br />Day Year <br />Transporter f PrinlecIT ame <br />J <br />o 6 <br />z2 V <br />fL <br />d <br />N <br />2 PrinteNfyped Name Signature <br />Month <br />Da Year <br />y <br />QTransporter <br />t- <br />18. Disaeparxy <br />18a. Decrepancy Indication Space Quantity ❑ Type ❑ Residue ❑ Partial Rejection <br />�I Full Rejection <br />Maniest Refuenoe Number. <br />18b. Altenwte Facility (a Generator) U.S. EPA ID Number <br />J <br />U � ` <br />11- Facilityrs Phone: <br />Month <br />Day Year <br />Li 18c Signature of Alternate Facility (or Generatorl <br />a <br />z <br />I�D755 19. Hazardous Wa Report Management Method Codes (.e., codes lex hazardom waste b9alm,60 disposal, and recyd ng systems) <br />w 1 2 3. 4. <br />G <br />20. Designated FaaTtty Owner a Gedification of receipt d h t curvered by the nw*st except as nded in item i Ba <br />Prince 1fryped Name Signature <br />Month <br />69ZL44 <br />Day Year <br />I& <br />tNA Form 8IUU-Z[ (Kev. 3-u3T rre"Ous earuons are ouscnme. r UtSllilVA i tU rA%-ILI r T r v UIZO 1 11'10r 1 +vr• Q r r+r � p- I ----"'--I <br />