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i <br /> e <br /> Please print or type,lForm designed for use on elite(I2- iicfi typewriter,) Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator 10 Number 2.Page l of 3.Emergency Response Phone 4.Manffast Tracking Number s <br /> WASTE MANIFEST C A D 0 2 8 2 7 7 0 3 6 1 (800)424-9300 018 2 3 3 6 7 4 JJ K '.., <br /> 5.Genmalers Namo and Mailing Address Generators Bile Address(if different Nan mailing address) s <br /> ASBURY ENVIRONMENTAL SERVICES '.. <br /> 1300 S.SANTA FE AVE <br /> COMPTON CA 90221 <br /> Generalors Phone: 310 886-3400 <br /> 0,Transporter I Company Name U.S.EPA ID Number z <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7,Transporter 2 Company Name U.S.EPA IO Number <br /> 8,Designated Facility Name and Site Address US.EPA ID Number <br /> ASBURYENVIRONMENTALSERVICE-CERES £ <br /> 1920 MORGAN RD. <br /> k <br /> CERES CA 95358 CAL000393680 <br /> Facllim'sPhone; 209541.1825 <br /> 9a, gb.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Conlelnem 11.Total 12,Unit 13.Weals Codes <br /> HM and Packing Group(Irony)) No. Type Quantity WINai. <br /> 1. NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OIL) 221 ! <br /> g 001 TT ? G <br /> Z 2, s <br /> i _ <br /> 3. ; <br /> a. <br /> r <br /> .-7—Speclalliandling InstswcGow,and Additional Information ' <br /> EMERGENCY CONTACT:CHEMTREC 1-800.424-9300 WOES TERMINAL,* APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT* <br /> EMERGENCY CONTACT CHEMTREC 800-424-9300* TRUCK# - ,� <br /> ) <br /> 16, GENERATOR'SIOFFEROR'S CERTIFICATION:ihereby declare that the contents of this consignment ate fully and accurately described above by the proper shipping name,am em classified,packaged, <br /> marked and lsbeledlplacarded,and are In all respects In proper condition far transport according to applicable international and national governmental regulations.If export shipment and l am the Primary <br /> Exporter,I today that the contents of this consignment conform to the terms of the attached EPAAcknowiedgment of Consent, —} f <br /> I certify that[he waste minlmizalion statement identified In 40 CFR 262.27(a)(if l am a large quantity,generator)or(b)(if I am a small quantlyr flowgilll two, OL r2 <br /> Gancrators/Offerars Printed/Typed Name Signature Month I Day Year F <br /> 16.International Shipments <br /> r ❑import to U.S. ❑Exportrem 0.S. Pod of entrylexlb <br /> Transporter signature(for experts only): Date leaving U.S.: <br /> Ix 17.TranspoderAcknowledgmentof Receipt of Materials - *` <br /> �2 Tr.nspeller I PBnledf(ypad Name Signal / Month Day Year <br /> 0 <br /> 7d. Trans oder2 Pranteng I yped Name Signature Month ar j <br /> s <br /> .N 18Discrepancy <br /> 188.Discrepancy s <br /> Indication Space n Quantity ❑Type ❑Rasidue ❑Padlal Rejeciton ❑Full Rejection y <br /> Manifest Poll Number: <br /> 186.Alternate Fectlity,lel Generator) U.S.EPA ID Number <br /> V <br /> LL Facility's Phone: <br /> W las.3analure of Nlernale Faclllly(or Generator) Month Day Year i+ <br /> Z <br /> t <br /> 10.Hazardous Waste Report Management PAelhad Lodes(Le.,codes for hazardous waste Treatment,disposal,entl recycling systems) <br /> I, 2. 3. {= <br /> ... 4 h <br /> 20.Designated Fnlil Dvaimor Operator;Coral of receipt of hazardous materials covered by the manllasl exrn aan .din Item lat <br /> pdnledlTYPed Nmnm Signmur Month Day % <br /> mf 8700,22(Rev,305).Previous willlolls are obno ate. -rZt'NTMn FACILITYTO DESTINATION STATE(IF REQUIRED) p <br />