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'MAIC-12-2005 13:54 FROM:TRACY T ICK & AUTOS 12098325307 T :4683433 P.12 <br /> $Faro of Golihxnia�EnvirQnmental Protection Agency <br /> Faryt Approved OMB No 2050-0079(Fxpiras 9.70.99) See Instructions on back o ®e 6. Dtlpartmant of Toxic Substances Control <br /> Please print or type, 'Form designed-for 0A&art&J146112-pitch)lypowritor. Sacramento,Coliforniu <br /> .4 UNIFORM H�►ZARD®US 1. Generators US EPA ID No Manifest Document No 2. Page 1 Information its the shaded areas <br /> (MANIFEST � �� ��� � � all <br /> is net required by Federal law. <br /> WASTE <br /> 3. Generator's Name and Mnihng Addressq .Y,a�•�s�6 y � A. state Manifest Document Number 99771056 <br /> ' "i-ssiz' B. State Generators ID <br /> n4 Gen3erator's Phone f I <br /> h5. Transporter 1 Company Nome 6. u$EPA ID Number C. State Transporter's ID IRs .1 <br /> 00 rOs'J�o ASBURY ENVIRONMENTAL SERVICES 0. ra_n <br /> sporters Phone <br /> ay (.310)886-3400 J.) <br /> ✓ Y. Transporter 2 Comp" Namo 8. US EPA ID Number EState7ronspor°r's D[Receive <br /> I <br /> _ <br /> .�0+rs� Y F, Transporter�s Ph.. <br /> s es+V 99eaD,tossion�nrtrrtgd facility <br /> Name <br /> and Site Address 10. US EPA ID Num6ar G, State Facility's ID <br /> IP"4 Q AJ(.!'IGCVI 0.'iy �{ 16I�RJLAIif <br /> a ®' <br /> tette, 1 =ES M sm fi, Faciliry's Phony ���..w °"71 <br /> 0O .L <br /> JQ12. Containers 13 Total 1A. Unit <br /> V <br /> 11. U$DOT Description(including Pieper Shipping Noma,Hazard Class,and!D Number) No. Type Quantity, Wt/Vol {. Waste Number <br /> Z o.ICNJCRA HAZARBOUS WASTE. LIQUID state <br /> ;-C <br /> 72z- <br /> 3 G (WATER(OIC.) No Placard Required � EPA/0111W <br /> ESao N13 E <br /> state <br /> R b THIS WASTE STREAM HAS BEEN QUALIFIED FPA/Other , <br /> FOR RECY INGLIREATMENT AT INE <br /> g T DeMENNO/KERDOON FACILITY IN COMPTON, Slate <br /> cc 0R <br /> CALIFORNIA.THIS FACILITY HAS THE NECESSARY EPA/°'he' <br /> PERMIT-STo�t d. �� Sro`a <br /> Z QUAUFIEQ OUR EPA NUMBER IS CAT080013 Uj <br /> EPA/p�ter <br /> v <br /> (A J. Additional Descri tions for Marorials listed Above <br /> Z p K Handling CodAbr astgs listed Above <br /> 10 <br /> V) <br /> OIL .5d. <br /> 0 f5. Special Handling Instructions end Additional Information <br /> Z <br /> ab b M RCTgE�i., Ftp t31V =t <br /> J 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately doscri6ed above by proper shipring name and are classified,packed, <br /> l41 marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable International and natlong government regulations. <br /> If 1 am a large quantity generator,I certify rhos I have o program in place to(educe the volume and toxicity of waste generated to she degree t have determined to be economically <br /> practicable and that I haw selected the racticable method o treatment,storage,or disposal currently nvailabla to mo which minimizes the present and future lltteal to human health <br /> and the environment;OR,if I am a small quantity ganerntor,I hove made a good faith effort to minimize my waste generation and select the bast waste managame It method that ii <br /> O <br /> available to me and 11101 1 can afford <br /> } <br /> Printed/Typed Name SiVAonk <br /> Yoat <br /> B17 Trans rter I Acknowledgement of Receipt of Materials <br /> sty � Pri ed Noma �B� 5}p Month Da Yvar <br /> S d- dl <br /> W P <br /> W 9 l S. runs rter 2 Acknowledlitmant of Rec li t of Mata* Is <br /> R Printed/Typed Name Signature Month Day Year <br /> T <br /> vsV3 E <br /> B <br /> V F 19 Discrepancy Indication Space <br /> Z A <br /> C <br /> L <br /> 1 20 Facilily Owner m O'arutV.C 3iwn "of rbcoi I of Isucorduvs moiatiab caYared b mest <br /> this uni —excelill us noted in Ittlrn I <br /> I Prinled/Typed o tl Signatur D a <br /> Y <br /> DOOT TE BE LINE. <br /> tinAY-1'::w T:iDF ZEND8 THIS COPY TO GENERATCR WITHIN '!u D'A'r° <br /> 'DISC 0022A(1/991 tor,r,"ritcr:; whc. stiihmit F7rnrdcus waste fzr ^!orrperl ctai s f:. air <br /> FPA 11700-22 flrn7'rc4 omplo.A -tPy of Ihrx cot.y and so-d to DTSC within ;v �41Y:4 <br /> .r <br /> d'� <br />