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Pleaso yalrll or tyre, Fomt des qw, for use on elite ( 12•1111ch) Iy temilot) form Approved, OMB No, 2050.0039 <br /> UNIFORM HAZARDOUS 1. Generator ID Number 2. Pago 1 of 3. Emergency Response Phone 4, Manifest Tracking Number {� <br /> WASTE MANIFEST CAL 0 0 0 16 2 6 4 6 1 (800) 424- 9300 _ 014058490 JJ K <br /> to x stfor 9 alibi P ! f?acs Gm m, ILASiL Address lif dillemet than and M acicifecs) <br /> n 10 97 <br /> 730 S , BECI<MAN ROAD <br /> LODI CA 95240 4715 N , WEST LANE MONTHLY BILLING <br /> Gel erYor's 1 hd u 209 9521.662 STOCKTON CA 95210 <br /> �vlef l C0,11 rany Nome <br /> U,6. EPh1U Numkb�a <br /> 0. Trans <br /> ASBUR(! ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> T Trnspr4ler2 C01111KIMY Nmpe U.S, EPA It) Number <br /> B. Dos?g3, ECU,LOGYVCRN ZINC u•s, EPA IttNumber <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 CAD 0 9 7 0 3 0 9 9 3 <br /> Facit!I esPhone; (323)2771500 <br /> ga 9b, U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Contalneta 11 , Total 12. Unit 13. Waste Codes <br /> HM and Packing Group (if any)) No, lypa Quantity WLNol, <br /> 11 NON -RCRA HAZARDOUS WASTE, SOLID (OILY SOLIDS- PAPER FILTERS 352 ( �1 <br /> rx <br /> o f D ' '0 P <br /> LU <br /> c3 <br /> 3. <br /> a. <br /> 14. 5(:cci.;l Harid6ng bsb,krvn; aru} Ad;f#I�nai InY,rrnnlaut �—}`�,� <br /> EMERGENCY CONTACT : CHEMTREC 1-800-424-9300 NAERG# 961 : 171 * PROFILE # 981 : AP192210 OILY SOLI S PC t <br /> FILTERS * P500-00022093 * APPROPRIATE PERSONAL PROTECTIVE EQUIPMEN / <br /> 15. GENERATOR'SlOFFEROR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by the proper shlpping name, aryl are classified, packaged, <br /> marked and labeled/placarded, and are In all respects In propercondlUon for transport according to applicable International and national governmental regulations. If expert shipment and I am the Primary <br /> Expodor, I codify that the contents of this consignment conform to the terms of the attached EPAAcimowledgment of Consent, <br /> I cediy that the waste midmlzallon statement identified In 40 CFR 282,27(a) (If I am a large quanely goneraloi) or (b) (If i am a small quantity generator) Is true. <br /> Generator'slOUeroes PnoledtiWed Name Sk nsturo Month Day Year <br /> ILI <br /> 16: intsmation Shlpmants <br /> ❑ import to U.S. ❑ Export from U.S. Pad of entrylexli: <br /> Tr nspWor signature (for exlwds only): Dale lean ng U.3'4 <br /> W 17, Tnm.*p0orAcfutottfedgmenl of Receipt of Materials <br /> WTraw r^ . 1 PrinlodayVed N�+e S gnalulo ASanGr Day Yanf <br /> Q _ <br /> Tmacpodar2PrmIcdr dName n MonthDay Year <br /> 18, Discrepancy r—, <br /> 18a: Discrepancy Indication Space El Quantity Type u Residue ❑ Partial Rejection Fuli Re)acilon <br /> Manifest Reference Number. <br /> 18b, Alternate Facility (or Generator) U.S, EPA ID Number <br /> jtdi. Factl ty's Phone; <br /> w 10cS:giurYuroofAketnateFacility for Generator) Month Day Year <br /> d <br /> 19, Hazardous Waste Report Management Method Codes (I.e., codes for hazardous waste IrealmeM; dlsposel, and recycling systems) <br /> 0 1 . 2. 3, 4, <br /> 20, fleslgroliA l4or y Owrk r of amlai. Cedigwtion of recelpl of hazardous materials covarod by Ura manifest exempt as n:lyd In ([am 18a <br /> Ptb�lledlyTweNmnm signabare eno,t Day Year <br /> EPA1"oo 700.22 (Rev. ft05) Previous editions areobsdate, DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />