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L <br /> Ptease print or tyOls, fp0ed for use on elile.(12�pitch)typewriter Form Approved.ONE No.2050-0039 j <br /> UNIFORM HAZARDOUS LGonaratorlD Number 2.Fageioi 3:emargeney ReaponSo Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST '\L 0 0 0 2 9 0 J. 3 1 Cts )a.4 017468641 <br /> A C �[; A.4 J J K <br /> 6.Gan�i�lp�' '��Ie ei�dwja�I�r�AddmsHA(VIIILR LANE Generators Site Address(if different than mailing address) SFO V`F 1. <br /> 307 i L NNiVIMLR LANE <br /> 'IOC iii Crit <br /> Generators Phone: S�;J 1�. <br /> S Transporter 1 Compan Name U S,EPA IDNumber <br /> I yI <br /> 4JOPI.DULINVjhiotJAIL'NIALSCRVIt,ES U +.U0-z ! 7 U <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> S.Designated Facility Name and She Address U.S.EPA ID Number <br /> US Iit.OLOGY VEflNON INC I <br /> 5375 S001 li 130YLL AVENUE _ ! <br /> LCIS ANGELES CA 900[).9t - <br /> i;ADf1y i 0J0�I <br /> Facilil?s Phone: (323)277-1500 <br /> 9a. 9b,U.S.DOT Descdplbn gradu ling Proper Shipping Name,Hazard pass,ID Number, 10,Containers e' <br /> HM and Packing Group(if any)) ti.Total 12.Unit %Waste Codes <br /> No. Type Quantity WlJV01. <br /> NOIV-RCRP,HAZARDOUS WA`A E,30 LI D(5 RAKE LpdNE SIiNVINGS) <br /> m <br /> U 2. <br /> 3. <br /> F <br /> A. <br /> 14,Spec al Handling Instructions andAddifional Information <br /> EMERGENCY CONTACT :CHEMTREC 1-800-424-9300 WOES TERMINAL: NAERG#961 : 1'71 "'PROFILE#961.AP-r-j3)-57-9 S-1 <br /> BRAKF. IAI I'IE SHAVINGS °r P500-00064771 ° APPROF'RIAI E PPE EQUIPMENT <br /> ) <br /> 15. GENERATORVOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fullyand accurately described above by the proper shipping name,and are classified,packaged, 77 �P <br /> marked and labeled!placarded,and are In all respects In proper covilllon for transport according to applicable International and national governmental regulations,If export shipment and l am the Primary t F <br /> Exporter,I certify that Ne contents of this consignment conform to Ne terms of the attached EPAAcknowledgment of Consent. a <br /> I cartity that the waste minimization statementldentiged In 40 CFR 292.27(a)Of I am a large quantity generator)or(b)Of l am a small quantity generator)Is two. t) <br /> lorslOgere's Pdnledrlyped area tin urs Month Day Year t I <br /> z- <br /> 16. <br /> international SVMIS IsNJ <br /> Import to U.S. ❑Exportfrom U,9. Pod ofenlrylexil: _ <br /> Transporter signature(for exports only): Date leaving U.S.: I <br /> &' 17.InnamporterAcknowledgmenl of Receipt of Materials <br /> GmnspoderI l typed NO Slgnature Month Day Year �I <br /> 116 1 Z e <br /> Transpodar21'nleCtly am Signature Monty <br /> 4. 15,Dlsompanoy I �' <br /> iia.01screparwy Indication Space ❑ Quantity ❑Typef El Full Rejection r <br /> ❑Residua ❑Partial Re action <br /> j �II <br /> Manifest Reference Number: <br /> lab.AHemale Facility(or Ganerslor) U.S.EPA ID Number <br /> U � <br /> t Fadlitys Phone: I <br /> w18o,Signature of Alternate Facility orGenerator) Month Day ear i <br /> 19.Hazardous Waste Report Management Method Codes P.O.,codes for hazardous waste treatment,disposal,and recycling systems) i L <br /> 2, 3, <br /> i <br /> 20,Designated Facility Owner or Oparafor Certificallon of receipt of hazardous materials severed by the manifest except as noted In Item NO _ <br /> PriniedRyped NZ= oq <br /> Signature Merin Day ear r <br /> EPA Form 05) Previous editions are obsolam, DESIGNATED FACILITY TO DESTI -0710th STATE(IF REQUIRED) <br />