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017792479JJK <br /> Please print or type.(Farm designed for use on elite(12-pitch)typewriter,) Form Approved.CMB No.2050-0039 <br /> UNIFORM HAZARDOU51.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Man 111catTreeking Number <br /> WASTE MANIFEST CA-60001 7.1 V1 3 i 480n)42'U23( 017792479 J J K <br /> S.Generators Name and Mailing Adtlress Gene cars ite cess rf diNeren!than malOng address) <br /> C..RTIFIEp C"WSION CENTER_-. <br /> G7710 MURRAY DRIVE <br /> GeneraYaTaA}oC�feON CA 95210 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 'ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7Transporler2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and SlloAddress U.S.EPA ID Number <br /> US ECOLOGY VERNON INC <br /> 5375 SOUTH BOYLE AVENUE <br /> Facllii <br /> 1s(S AN <br /> s: GELES CA 90058 CAD097030993 <br /> = go, 9b:U.S.DOTestern(Includ'ng Proper Shipping Name,Hmard Class,ID Number, 10.Contalnera T1.Total 12.Unit 13 Msto Codes <br /> HM and Parking Group(d any)) No. Type Quantity WLNo1. - <br /> 1. <br /> Ing NON-RCRA HAZARDOUS WASTE,SOLID(BONDO DUST) <br /> r <br /> DM P q r19 <br /> 2 2. <br /> W <br /> c.7 <br /> 3. <br /> 4. <br /> 14,Spada)Handling Insburtions andAdditional Infornra0on r�/�❑r ,f A <br /> EMERGENCY CONTACT:CHEMTREC 1-800-4249300 WOES TERMINAL:CERES C5 *PR0f9LE#9B1:588536 80ND0 DUSITd*-�J(R�[O <br /> 0500.00054319*APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT #z-o" )X515- <br /> 15. GENERATOR=FFEROR'S CERTIFICATION:I hereby declare that the omtents of this consignment are fully and aavratelydescribed above by the proper shippEng name,and are dassified,packaged, <br /> marked and labeledlplacmrdvd,and are in all respects in proper oondi'tion for transport according to apficable intema0mal and national governmental regulations.11'wWshipmentand1amthePrimary <br /> Exporter,Icertifythatthecontentsofthisconsignmentconformtothete=oftheaft chadEPAAdmowiedgmentofCo <br /> Ioestatementi <br /> rtifyVAthewasteminim�ationdenifiedIn40CFR262.27(a)[fIamalargequantitygenerator) r{b} as genera"Is true. <br /> Ge r A;rIaPfinb8dIrype:dN� tutanth Day Year <br /> 2 D Lfj 02- 'P <br /> j B.Irdemationa€Shipments <br /> F- ❑ImportcU.S. ❑ExpatirtomUS. Part olentry7ezit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.TranspeerAe�movA,edgmerdofReceipt ofMaterials <br /> Transpire tadlf Na a Signature March Day Year <br /> a b �0 <br /> W <br /> Transp ntedliyped a signature Month Day Year <br /> 98.Discrepancy <br /> 18a.Dlsaepanky Indication Space ❑ Quantity ❑Type <br /> ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Altemats Facility(or Generator) U.S.EPA ID Number <br /> .J <br /> U <br /> IQ Facility's Phone: <br /> W 180.Signature ofAltemate Facility(or Generator) Month Day Year <br /> a <br /> a <br /> 19.Hazardous Waste Report Management Method Codes(i.e,,codes torhazardous waste lreatrnen%disposal,and recycling systems) <br /> 0 1. 2. 3 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials oovered by the manifest except as Dowd in Item 16a <br /> PrintodrTyped NameSignatue Month Day Year <br /> .�— <br /> sE)k o 0 <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY T&D&TINATION STATE(IF REQUIRED) <br />