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Please print or type. (Form designed for use on elite (12-01ch) typewriter.) Form Approved. OMS No. 20500639 <br />UNIFORM HAZARDOUS i. Generator ID Number 2. Page 1 of <br />` 0 0 0 7 3 5 8 5 4 <br />3. Emergency Response Phone <br />goo) 424-9300 <br />4, Manifiat Tracdng Number <br />1008823080 J J K <br />WASTE MAN)FEST C A R 0 <br />5. Generator's Name and Mailing Address Generator's Sita Address (d different Vett mailing address) <br />TRACY TOYOTA - TRAM <br />28M NORTH NAGLEE ROAD <br />TRACY CA 96376 <br />Generator's Phone: 209834-1111 <br />6.Transporter 1 Company Name U.S. EPA ID Number <br />C A D 0 2 6 2?? 0 3 6 <br />ASBURY ENVIRONMENTAL SERVICES <br />7. Transputer 2 Company Name U.S. EPA ID Number <br />8. Detignafed Fadiq Name and Site Address U.S. EPA ID Number <br />SIENC-NS WATER TECHNOLOGIES CORP. <br />5375 SOUTH BOYLE AVENUE C A D 0 9 7 0 3 0 9 9 3 <br />LOS ANGELES CA 90058 <br />Facws Phone. =11277-1900 <br />ga. <br />9b. U.S. DOT Desmplm (mduding Proper Shipping Name, turd Class, ID Number, <br />10. Ccntaitere <br />11. Total <br />12 U118 <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (f any)) <br />Quantify <br />WtArd. <br />1. <br />181 <br />NON-RCRA HAZARDOUS WASTE, SOLI Q {BRAKE LATHE SHAVINGS) <br />' <br />DM <br />P <br />z <br />2 - <br />LU w <br />t9 <br />3. <br />4. <br />k <br />14. Special Handling Instructions and Addttiorral Information` <br />4 NAERG# 9B 1 11111 BRAKELATHE <br />lPRORLEEQU1PNEN 9ffJ°/ <br />EWRGENCCONTACT-CM <br /># % �iu <br />SHp�VINGS' Al `10 136727EAPPROPR�IAa7E PERSONAL PROTECTIVE <br />15. GENERATOR'SADFFEROWS CERT FICATfON: I hereby declare Ucat the contents of this consignment are fully and accurately described above by the proper shipping name, and are dassfiad, packaged, <br />marked and labe"placarded, and are in al nespeds in proper condilcrl for transpon according to applicable international and national govemmenta l regulations If export shipment and I am ne Primary <br />Exporter. I certify that Cie contents of this con*rmwt conform to the terms of the attached EPA Acknowledgment of Consent <br />I certify that the waste narimizatim statement identified in 40 CFR 26237(a) (it I am a large quantity generator) or (b) (dl am a small gtmrttity generator) is true. <br />Generalor'slOUerces PrinteCyped Name Signature Day Year <br />L <br />16. International Shipments <br />❑ Import W U.S. Export from U.S. Pori of erdryledt <br />t— <br />? <br />Transporter signature (for exports only): Date leaving U.S.: <br />17. Transporter Acknowledgment of Receipt of Materiels <br />Transporter 1 PrinledrT erne <br />O <br />n S ynahxe Month Day Year <br />06 22 V <br />a <br />`Jjl <br />QTransporter 2 PrintWypeed Name Wi atufe Month Day Year <br />1-- <br />18. Discrepancy <br />18a. Discrepantcy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Part al Rejextion ❑ Rill Rejection <br />Manifest Rete mnoe Number. <br />18b. Alternate Facility (or Generator) U.S. EPA 10 Number <br />J <br />res+ <br />U <br />Fadfitys Phone Y <br />w 18c Signature of Alternate Facility (orCeneradr) <br />=ay Year <br />a <br />Z <br />F,S 19. Hazardous Wes Report Management Method Codes (.e., codes for hazardous waste .reatnent, disposal, and Ncidmg systems)ul <br />1. <br />Atul <br />2. T <br />- /11? <br />4. <br />1 <br />20. Designated FaaTrty Owner or Opeow. Certification of reotpt of h&;AmE!le0w#ered by the martlest exc NA as noted in Item 188 <br />Priniedffyped Name Signlawre -;KMonth Day Year <br />EPA Fortin 8700-22 (Rev.3 0 sed DESIGNATED FACIL 70 DESTINA STATE (IF QUI ED) <br />