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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1 . Generator lD Number 2. Page t of 3. Emergency Response Phone 4 Manifest Tracking Number <br /> WASTE MANIFEST CAL 0 0 0 2 6 4 1 3 2 1 (800) A24 9300 016 2 3 6 5 0 5 JJ K <br /> 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) <br /> 711 MATERIALS INC - 711002 <br /> PO BOX 3191 2714 STAGECOACH <br /> Genarotors Phone: <br /> 209 a$3-4730 <br /> Pvi CA 9r 354 STOCKTON CA 95215 <br /> hone: ,. <br /> 6. Transporter 1 Company Name U.S. EPA ID Number t <br /> ASBURY ENVIRONMENTAL SERVICES CAD 028277036 <br /> 7. Transporler2 Company Name U.S. EPA ID Number <br /> ( <br /> 8. Designated Facility Name and Site Address LLS. EPA ID Number <br /> US ECOLOGY VERNON INC <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 CAD097030993 <br /> Facillys Phone: (32n)277-1500 . <br /> ga gh. U.S. DOT,Oescripfion (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11, Total 12, Unit 13. Waste Codes <br /> HM and Packing Group (if My)) No. Type Quantity WI.NoI. <br /> W 1, PION -RCPA HAZARDOUS WASTE, SOLID (OILY SOLIDS) �, ,j'�� 352 1 <br /> o DM <br /> P —� -- <br /> 1 <br /> w 2, NON-RCRA HAZARDOUS WASTE, SOLID (OILY SOLIDS) ! �} _352 _ <br /> I <br /> 3. <br /> ( III <br /> 4. <br /> 14. Spepal Handling lnsimcGons and Additional lnformaeon - 26C <br /> EMERGENCY CONTACT : CHEMTREC 1800-424-9300 NAERG4, 981 : 171, 9132 : 171 PROFILE ill 9131 : AP201815 OILY t k <br /> SOLIDS, 9B2 : P205533 OILY SOLIDS * P500-00046588 * APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT/ 57 <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATION: I hereby declare Nat the contents of this consignment are fuilyand accurately described above by the proper shipping name, and are classified, packaged, <br /> marked and labeledfle acarded, and are in all respects in proper condition for transport according to applicable marnafionai and national governmental regulations. If export shipment and i am the Primary <br /> Exporter, I certify that Ne contents of this consignment wnform to the terms of the attached FPAAcknowledgment of Consent <br /> certify that Ne waste minimization statement identified in 40 CFR 262.27(a) (if [ am a large quantity generator) or (b) lift am a small quantlty generator) is we, <br /> Generaio(sr0lfemrs Printed/typed Name Signature / Monl <br /> t D Y <br /> i a <br /> -a 16. International Shipmentsimport to u's. ❑ Export from US. Pod of entry/exit: <br /> ~ Date leaving U.3,: <br /> z Transporter signature (for exports only): <br /> 17. TianspoderAcknowledgment ofRecefptof Materials <br /> Transported Pdnted/iyped Name / � SignaNre �:J / M Oa ar <br /> Monty Day Year <br /> Taanspoder2Printed(Typed Name Signature <br /> f- <br /> 18. Discrepancy € <br /> 18a. Discrepancy ludicafion Space Quantity [-]Type ❑ Residue ❑ Partial Rejection El Full Rejection [ <br /> Manifest Reference Number, <br /> U.S. EPA ID Number <br /> IBb.ARernate Facility (or Generator) <br /> U <br /> Faulis Phone: _ t <br /> Month Day Year <br /> 18c. Slmo reoiAlfemate Faclity (or Generator} <br /> z . <br /> 19. Hazardous Waste Report Management Method Codes (i.e., elides for hazardous waste treatment, disposal, and recycling systems) <br /> w 1 2 3, 4. . <br /> P ' <br /> 20. Designated Facility Owner or operator. Certification of receipt of hazardous materials covered by the manifest except as listed in Item IBe <br /> PrintedRyped Name <br /> Signature Month Day Year <br /> I <br /> i <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATES FAMLIY 1( TO DESTINATION STATE (IF REQUIRED) <br /> ( <br />