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Pin asn€,, t-evlyr,. . ftim desicgried for (1eo on elite ( 12-pitch) typetivritm .) Form Apwolled, OMB No. 2050.0039 <br /> UNIFORM HAZARDOUS Generator ID Number 2. i ofage 1 of 3, Emergency Response Phone 4, Manifest Tracking Num er <br /> WASTE MANI ' t <br /> Page CAL 0 0 018 2 6 4 6 ' 1 I (800) 4249300 014057515 JJ K <br /> 6, General?ros No P UVL!4#42 lmu Goneralor s Site Address (if different Ihan mailing address) <br /> J73�r0r�'YrS. BECKMAN ROAD <br /> LODI CA 95240 471.5 N , WEST LANE MONTHLY BILLING <br /> E GonamlorsPnone: 209952.1662 STOCKTON CA 95210 <br /> r , TransfqlS 'iPINVIRONMENTALSERVICE S u.s' eP�(r�l~ -W12 8 2 7 7 0 3 6 <br /> ( <br /> 7: T110wir}r 2 Company Nawm U S. FPA IU Numilct <br /> j <br /> e, Designated FacildName an SnoAddress U,S, EPA ID Number <br /> EVOQUX WATE�i TECHNOLOGIES LLG <br /> 5376 SOUTH BOYLEAVENUE <br /> LOS ANGELES CA 90058 CAD 0 9 7 0 3 0 9 9 3 <br /> Faculty's Phone; (323)2774500 <br /> 9a. gb. U,S, DOT Description (including Proper Shipping Name, Hazard Class, tD (dumber, 10, Containers 11 . Total 12. Unit 13, Waste Codes <br /> HM and Packing Group (Ir any)) No, Type Quantity WINoI, <br /> 1 . NON-RCRA HAZARDOUS WASTE , SOLID , (OILY SOLIDS- PAPER FILTERS 352 <br /> D �0 P <br /> 2, <br /> w <br /> 0 <br /> 3• <br /> 4. <br /> y <br /> 14. $pedal Handling Instructions enol Addi tonal Infaanaibn <br /> EMERGENCY CONTACT : CHEMTREC 1-800.424-9300 NAERG# 9131 : 171 * PROFILE # 9131 : AP 192210 OILY SOLIDS- PAPER <br /> FILTERS * * APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> 15, GENPR(1TGA, toFFERoR,s CERTIFiCATiONt I hnroby rfec6nro tlrel Um rxntenls orirds stltstg tetani a fully on9 acs o aly dr c�ibrd nl ova My Iha prof ar s¢ ping nnrna, a d ora da'ssit ad, packaged, <br /> marked nr?rl labeladrp?�.rsded, and :rrdinaU rc�po� hl proparcnrA+thn tpr irntsprdl accad?ng Ra appfrrekln GttarnnUonfa!r�raf natwnal ga� omrrxsn'.al ragufallons Ii ax�si al�rmant and I am U;e Prhnary <br /> Cxportot, i cedlfy ihailha r�nlonts of USS aorn;lgnmsnl wnfarmta iha Ientnn ntlho aNachad CPAAcyno++"odymsnl of Gor+seni. <br /> ► rori fy Unal Uw aasla mtnvnlzagon siatamont Idanlnmd In 40 CF8 2{f?.27(a) (if l am a large quantity gonarrdor) or (b)"(iil nm a atna!I qunnlltyganernlorj fs (nrp, <br /> GerroraYslOffomoes PthItedfliord Name 910l tJunth Day Yoar <br /> ,5 I 3o <br /> 10. International nal Shrprmi ❑�_� Import to U.S, Pod of enUY(exit;Er�ort from U.S. <br /> Trnnsftoriorsignaturo (for exports only): Date leaving U.S,; <br /> 17. TransporterAckrordedgment of Receipt of Materials <br /> Trans or 1 Pdn%Oyuad — Signal ao hiornh Day Year <br /> mrispoder2PrintehT ad Name rgnalrae Month Day Yew <br /> 16, Discrepancy rr---� <br /> 10a. Dl=epancy Indlcailon Space Quantity L _! Type ❑ Residue ❑ Partial Rejection ❑ Full Ref ecllon <br /> hrnnitest Reference Numhor. <br /> 10h, Allernalo Fadiily (til Grnorator) U.S. EPA ID Numbor <br /> V <br /> w Fa6l,ty's Photic; <br /> Pu ilio. SUnaturoofAilernateFachily (or Generator) Month Day Year <br /> Q <br /> z <br /> 05 19. Hazardous Waste Report Management Molhod Codes (Le., Cedos for hazardous waste treatment, disposal, and reWdlog systems) <br /> 14 <br /> 20. pesfgnaWd PadiAy Owner or 0pernlort Cediflcatlon of meefpt of hazardous materials covered by the mon Post excapi as nd d In Item lea <br /> Prnfcafll � odtJnmo z Shg alnno Month Day Maar <br /> EPA Fomi87*22 (Rev. 3405 Previous erfillonsare obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />