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ki� <br />Please print or type. (Form designed on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050 0039 <br />7- page 1 or 3. Emergency Response Phone 4, 1142nifest Tracking Number <br />UNIFORM HAZARMUS <br />I <br />11, Generator ID Number <br />-24 =.I <br />CV% <br />1013082557 JJK <br />WAS'11 MANIFEST <br />1 -0 A L 010' 0 2 22 7 ;8 2 <br />5. Genefator's %e �ndffalrm i Generator's Site Address tit different than mailing address) <br />Mallin Rj�3 I <br />1STOCKTON <br />Ho LT Ul`' 0V ', W11AFM RR "cz-VAY <br />.AN <br />OGenerator's <br />SPAO CR AMENTO <br />Phone: 209 <br />6.1ransporter I Company Name U.S. EAPA ID Number <br />D b <br />ASRURY r"pil "RONNMKNTAL SERVICES <br />7. Transporter 2 Company Name U.S. FPA ID Number <br />U.S. EPA M Number <br />a <br />8. Desi Facil P Niane aad Sit - ak�d;:J=s- <br />1, es, n ed' <br />wy <br />C-w <br />r L P 6ALE AVENUE <br />j <br />NO <br />En <br />LOS ANGELES GA Sklc-fs-s <br />L ANGELES <br />t. 2 S 6517=7 <br />Faclilly's Phone: <br />Phone: <br />Fac' s on <br />6VE <br />sc <br />9a. 9b. U.S, DOT Da-scrption (including Prcper Shipping Name, Heard Class, ID Number, 10. Containers 11. TOW 12.0 3. Waste Cedes <br />U �01 <br />_rip —N. <br />Qu thy WLA <br />end Packing Group (If any)) F <br />HM Type <br />J. <br />NON-110RA HUI RE"OUS IWASTE -sOLID (OILY SOLIDS P 13152 i <br />Q-1 <br />3 <br />2. <br />Uj --------- <br />14. <br />Special Handling Instructions and Additional Information <br />- - -,,- - <br />--P-i !j M CY M -147 �U N i4100-4�24- <br />5,02 Zt� <br />6 -41 -7 -U� <br />r-'PA CODES : S-Si <br />0 <br />PEMOMAL FROTEG-WE EOUINPMENIT 19K�A e_- <br />fully and accurately described above by the proper shipping name, and are classfiled, packaged, <br />% <br />15, <br />OEKERATORSIoFFEROWS CERTIFICATION:: I hereby declare that the contents of this consignment a re <br />for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary <br />marked and labelediplacarded, and are In all respects in proper condition <br />Exporter, I certify that the contents of this consignment conlixrn to the terms of the attached EPAAcknoWedgment of CoMent <br />is true. <br />I certifythat the waste nftmizatlon statement identified In 40 CFR 26217(a) (T I ema large quantity generator )fir (b) (91 am a wq qua-ifibl gerieratcr) <br />Month Day Year <br />PdntedffypLd Name Signatur <br />d3-1/k <br />E-7 V4Cnt'�j Llvm LA- <br />-j <br />-e— <br />16. International ShipmentsExport from U.S. Port of entrylexit: <br />J [I import to U.S. <br />Transporter signature (for exports only): Date leaving U.S.: <br />a <br />LLI <br />17. TranspDrterAcknowledgment of ReceO of Materials Month Day Year <br />0 <br />Sign <br />Trarspaql Printecirryped Name <br />0. <br />Mont Day Year <br />�E <br />Transporter 2 Printed/Typed I`Zme ir ature <br />18. Discrepancy nn <br />Indication Space ❑ L Residue ❑ Partial RejLctiln ❑ Full Rejection <br />I <br />18a. Discrepancy Quantity Type <br />Manifest Reference Number. <br />— U.S. EPA ID Number <br />I 8b. Alternate Facility (or Generator) <br />LIC <br />Facility's Phone: Mc-ch :2", y e3 T <br />LU <br />1 So. Signature of Alternate Facifity (or Generator) <br />Z <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment disposal, and recyclIng systems) <br />G1 <br />2- <br />-1 M114f <br />20. Designated oacifity Owner or Operator: Cerliffcation of receipt of hazardous materials cove re"- the manifest except as notedin Item 18a <br />Monro Year <br />N <br />Printediffyped Name <br />] I <br />9ATE . iF41 <br />- R E'Q'UI EO) <br />EPA Form 8700-22 (Rev. 3-05) Prevlo6s� editions are obsolete. DESIGNATED FACILITY T 0 DEESTINATI NSTATEQ <br />