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017467915JJ K <br /> Please: plirit or (ypa': Form-des nod for use oneNte (12•ptic8 ,( pewnfor,) Form M> ro4o0. OMB No, 2050-0039 <br /> UNIFORM HAZARDOUS t Oeneramr ID Numbor 2. Page 1 of 3. Emergency Response Phone an foslTracldnp Numbof <br /> WASTE MANIFEST CAL 0 0 025 1 5 2 1 t800 ) 424• � 30u 017467,9115 J J K <br /> 5:GerrglnrsNgm6MLI�dQp�aSTERNMOTORS • CA6011 - GveraloesShe Address (Krfiferentthan malGngaddress) <br /> P .O. BOX 2186 s } C <br /> IJIAWI FCA CA 96336 1 .145 ,W1 `t'C�.". EN11il" E ANE <br /> 209 823• I.143 MANi tCA <br /> Qeneraln sPh.-0ne: <br /> 5lilren�o�1er1 TanyNetnq US: EP N umbor <br /> W�2T�L[?.'f ll; ! NVIRONMENTAL SERVICES C A 0 0 2 8 2 i i G 3 6 <br /> none ar Ga> pany amaL14S4 EPAID:Number <br /> 8" Des oared fad"��yykamo a Sbe Address U.S, EPA ID Number <br /> nal'EOOLUaI VERNON INC <br /> 5375 SOUTH 60YLE AVENUE <br /> LOS ANGELES CA 90053 CAD097030993 <br /> Fadiitys Prom: 323 2 7 7.1500 <br /> 9a" 90. UIS, DOT Desniptinn Qnduding ProparShipping Name, Huard pass, ID Number, 10. Containers 118YOlal 12, Unit 13* Wade Codas <br /> HM and Paddng Group (d any)) No. Type Quandty W1 Noll <br /> 1NON-RCRA HAZARDOUS WASTE, SOLID (BRAKF. LATHE SHAVINGS ) 181 ! <br /> 0M 1 P <br /> 2. <br /> f <br /> 3. <br /> 4. <br /> S <br /> j <br /> i <br /> ? 14" al andling instructions eiftvdAddWonallntw=Von <br /> t <br /> EMERGENCY CONTACT : CHEMTREC 1.8ODA249300 WOES TERMINAL: CERES CS NAERG# 961 : 171 * PROFILE tr 961 : <br /> ( B KE LATHE SHAVINGS * P500-00058386 * APPROPRIATE PERSONAL PROTE ' f E E UI MINT <br /> 32S? 52 <br /> 15, GENERATOWMFFE ORIS CERTIFICATION: I hereby declare that the contends of this consignment are MIN and accurately described above by the proper shipping name,and vm dassibed, packaged, <br /> madusd and labeledfplaeaMed, and are M all respects In proper condiilon for transport according to app{cabla lnlemadonel and national governmental regulations, if export shipment and I am the Primary <br /> Fxpn iar, l oa duhl <br /> the oar mrtta of 1111s !x ls�tgotnrgt}-tn(ard to @fa ttmt& of tl� atuxhed EPAhtkras uWdg crt o[Oonserrt <br /> 1 N1R mir**Agbn 4440m; tiaCPR 28227(x) (H I am a to g� qua ddy pans ator) ar jti) gI a quant ty generator) B bue. <br /> torzTOao ' n10;wr, Name & onus Day Year <br /> „r 6 11 Vif <br /> 1G. I " rot ' mems impar U.3, ❑ Export fm'm�t ofero <br /> Trans tdrslgnabao (iprcxportsanlj): <br /> Date tcavlrg . <br /> iz, Trenspafer Adatovriodgrr,ad d liecelpt a ► lateifats <br /> . Iran Si2nahauAll <br /> ur tMy Year <br /> f <br /> tri resporler2Pdnte&T Name Signalua Month y Yeti <br /> 18. Disaepancy _. " <br /> 18x. p saepancy fM catlon apace ❑ Quantity ❑Type 11 Rwdue El Partial Rejection ❑ Full R*Ww <br /> ManniiastRaf ante Number <br /> i1 b. Alternate Facility (or Generator) U.S, EPA ID Number <br /> U <br /> k t araVlys Phone: - <br /> �" I ---- Y ear <br /> w 1 S nature o te`FaciSy (a Generator) nn Da <br /> 7C <br /> ti 13, Hazarr)ous,N`asle Re{wrtManagameM Method Codes (Le, codes forfmardouswasto uvatrnont, disposal, and rocyding systems) <br /> - - - <br /> �4 �) 1 <br /> a 1 t l ? 3. 4 <br /> 20, Designated Parity{lunar (xQt Arras fated in Item 18a <br /> nt Ysw� ame atagout ayear <br /> EPA Form870042 ,pbv. n5)" Pit v)aus Gon§ are oD3at41tt, DESIGNATED FACILITY TO DEsfwATto4N STATE (IF 13601UMEO) <br />