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,c or type.(Form desl ned for use on elite(12-pitch)lypowriter.) Form Approved.OMB No.2050-0039 .NIFORM HAZARDOUS 1.Generator ID Number 2,Page 1 of 3.Emergency Response Phana 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 2 6 41 3 2 1 (800)4249300 018 3 6 5 0 5 JJ K 5-Genofalor's Name and MaHtngAddress Generators Site Address(if different than mailing address) 711 MATERIALS INC-711002 PO BOX 3191 MODESTO CA 95354 2714 STAGECOACH Genafator'sphone: 209943-4730 STOCKTON CA 05215 B.Transporter 1 Company Name U.S.EPA ID Number ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 7,Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address [J-S-EPA ID Number US ECOLOGY VERNON INC 5375 vr'OUTH BOYLE AVENUE LOS ANGELES CA 90058 CRD097030993 Faciittys Phone: 02 )277-1500 9a. 9b.U,S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group{if any)) 13.Waste Codes No. Type Quantity Wt.Nol. 1 NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLIDS) rr I i 0 i � 352 DM P y w NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLIDS) `(Jd 352 c� D IIrI P 4. 14.Special Handling Inslructlons and Addilional Information EMERGENCY CONTACT:CHEMTREC 1-800-4249300 NAERG#961: 171,962:171*PROFILE#981:AP201815 OILY�� Q SOLIDS,9132: P205533 OILY SOLIDS*P500-00046588 *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT 15. GENERATOR'SIOFFERQR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I dertify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(If I am a small quantity generator)is true. Generator'slOfferor's Printedayped Name %nature Mn 9 Y IJ 16.International Shipments I z [I import to U.S. Export from U.S. Port of enlrylexit: -- Tfarisporler signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials Transporter1 prl"34 Typed Nama Signaluro Mie p M Transporter 2 PrintedlTyped Namo Signature Mortlh Day Year >a[ H- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection ManiWt Reference Number. 18b.Alternate f-adllly(or Generator) U.S.EPA ID Number C.> LL FarillIft Phone: W 18c.Sdgnelure of Ai9amate FacHily(or Generator) h4011111 Day Year a Z U3 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLJ A 1' 2. 3• 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest excepi as noted in Item 18a Printed(r-yped NorneSignature Month Day Year C�A,'i 4 6�abx 1 I I 1T EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATE6 FACILITY T _STINATION STATE(IF REQUIRED)