Laserfiche WebLink
(Form designed for use on ekte,'2-pitch)typewriter) Form Approved.OMB No.2050-0039 <br /> ,,,AHAZARDOUS 1.Generator 11D'+-*neer 2.Pageergency Response Phone 4.Manifest Track' Number <br /> ,✓ASTE MANIFEST C A U S S 1 9 C 7 c 8 0 17' ( -24-93W UO)X1 017791242 JJ K <br /> 5,Gene,ator's Name and Mailing Address Generators Sive Address(if different than mailing address) <br /> DODGE INC <br /> nu 10 CENTER CJPGLi_ <br /> att.tt:;KT0N CA y5212 <br /> Generators Phone 477-3668 <br /> 6.Transaorter 1 Company%-.7m U.S.EPA.D Number <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name US EPA ID Number <br /> 8 Designated Facility Name and Site Address U.S.EPA ID Number <br /> !!S ECOLOGY VERNON INC <br /> 5375 SWN BOYLE AVENUE <br /> Faeilil(a PPhhonnOS eNGEiES `{,Jit 80Q58 C A D O 9 7 O 3 0 9 9 3 <br /> ga, 9b.U.S.DOT Description Qnduding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing croup(f any)) No. Type Quantaltity 12.Unit <br /> 13.Waste Codes <br /> QW 1 N06-RCRA HAZARDOUS WASTE,SOLID(BRAKE LATHE SHAVINGS) P t <br /> Z 2. <br /> W <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> f, <br /> _ EMERGEftY CONTACT:CHEMTREC 1-SW 424.8.9100 WOES TERMINATERMINAL:CERES CS' "PROFILE N 901;0412201801 BRok E <br /> LATHE WVIGNS*PWM005UN *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classed,packaged, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Ct. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)('d I am a large quantity general o> 'r r Yam small ry generator)is we. <br /> toes/Offerot's Printedfryped Name Signat 7Month Day Year <br /> ��. a16.international Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylexlt: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.TransporterAcknowledament of Receipt of Materials <br /> Transporter 1 Print ype Name <br /> !! ( Sgnature Month Day Yea, <br /> y I d t 'r <br /> Z Transporter 2 Prin a Name S ratwe <br /> g' onth Day Yea, <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Type ___� RApeAsi�d■■.,�ue ❑Partial Rejection ❑Fu I Rejection <br /> f leEI 1e <br /> 18b.Alternate Facility(or Generator) U.S EPA iD Number <br /> „� y 201FV IVI N. __ <br /> LL Facility's Phone: <br /> 18c.SignatureofAlternate Facility(or Generator) <br /> ENVIRONMENTAL Month Day Year <br /> 4 <br /> z <br /> W19.Ha7ardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 01. 2. 3. T- <br /> L' 20. <br /> Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the nvnnifpst except as noted m Item 18a <br /> Printed/Typed Name _ Signature Month Day Year <br /> �A i ( ii,l 1XCwil, - 6 <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete, DESIGNATED FACILITY TO GENERATOR <br />