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06t-08-04 03:45pm From-Asbury Env./ DK Dixon Customer Service 17076782297 T-298 _ P.003/004 F-221 <br /> Pleow prinlr,3r type. roan east®neo for ilea�n ou,o I, -r.. „•,. <br /> v�na'n� <br /> onorator's US EPA ID No. Mpnifost Document 2. Page 1 Information In the shaded oro., <br /> UNIFORM HAZARDOUS I,not required by Fodorol low. <br /> WASTE MANIFEST CAL 10 10 10 12 1 5 16 12 10 161 2 14 10 3 .0 <br /> 3. Generator's Name and Molling Address A. Stale Manifest Document Number'' <br /> 'k189WER 24024034 <br /> P STOCKTON CA 35216 B. Sloe Generator's lD <br /> A. Generator's Phone( 1)00()46.67 38 <br /> CNI S. Transporter 1 Company Noma 6. US EPA ID Number C, Slate Transporter's ID(Reserved.) <br /> in <br /> C? <br /> ASBURY ENVIRONMENTAL SERVICES C A 1) 0 2 B2 7 7 0 3 6 D. Transporter s Phone (800)9744495 <br /> top 7. Transporter 2 Company Name 8. US EPA to Number F..$tata Tnansparter'f ID fRasaryetij <br /> 'J <br /> —+ F. Yroneporlar's Phone <br /> 9. Designated Faeiliry Name and Site Address 10. US EPA ID Number G, Slate Facility's ID. <br /> d D 1 K-EI'MRONNENTAL <br /> 12 350 EAST 26TH STREET H, FociliVs Phone <br /> O q C .A T U 18_10 0 3 3 6 8 1 (M)26&W <br /> r=i OS ANGELEa 12. Containers 13. Total la, Unit <br /> J6 11. us DOT Description(Including Proper Shipping Noma,Hazard Class,and ID Number) No. Typo QuantityWt/vol 1• Waste Number <br /> C HAZARDOUS WASTE LIQUID, N.O.S,9,NA3082, P(3 III store 135 <br /> }i G EPA/Other <br /> E <br /> 00 NbN RCRA I-1,4Z1�l�tDOUS WASTE SOLID(OILY SOLIDS) Stale <br /> EPA/Onset <br /> v RNONE <br /> b T <br /> C. Stale <br /> ago O <br /> EPA/Other <br /> d. Stole <br /> U EPA(Olher . <br /> w <br /> Z 1.:'Addlgonal Deiqri flan <br /> p forlrtahari.slit d'Abova K: Hondling Ctidei for Waslos Listed Above <br /> W ( x �p; p sTA'f .CODE <br /> I <br /> h C. <br /> 0 15. Special Handling Instructions and Additional Information <br /> USE PPE EMERGENCY CONTACT;CHEMTREC 1-1300-424-8300 <br /> NAERG# 11A 171, 118. 171 <br /> 16. ENBR TOR'S CERTIFICATION: I hareity declare that the contents of ilth consignment are Fully and accurately described above by proper ship Ing name and ore classified,packed, <br /> U <br /> morW,and labeled,and ore in all respects in proper condition for transport by highway according to applicable Inlernallonal and notionargovornmani ragulations. <br /> IF I am a large quanli generator,I certify that I have a program in place to reduce the volume and toxicity of waste eanaratod to the degree I have determined to be economicallyy <br /> Is- praeliwble and that 1 have selected the Practicable melhad of ireotmenl,storage,or disposal currently available to me which minlmlxes the presoni and future threat to human heohh <br /> to <br /> and the environment;OR,If I am a into I quantity generator,I have made o good faith effort to minimixe my waste generation and-elect the bail waste management method that la <br /> tx available to me and that I can afford, <br /> O <br /> } P' edTyped Name on D Year <br /> Z t1k7. <br /> w T 17. T. jornattlit6f Reuel t of Motarlols <br /> W N Prin /T ped Name Signature <br /> ZE ^ - Month Day year <br /> w S ,1�\ It <br /> U_ p 1 e, Tionsparlar 2 Acknowled omant of Receipt of Materials <br /> 0 TflT Printed/Typed Name SlAnalur Month Day year <br /> U4 E <br /> R <br /> F 19. Discrepancy Indication space , <br /> ? A <br /> C <br /> I <br /> L <br /> 20, Facill Owner of Operator Certification of receipt of hazardous materials covered b s is manifest except as noted in Ilem 19. <br /> j Printed/Typed Name Signature Month Doy Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) While: TSDP SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />