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PkMe arit or NDe =r �_ rx is mff=� s ow 11 <br /> ILWORY PJVJ1Rt}0.S 2_ Page t ef 2 «nom - <br /> WIeTE NAMFEST <br /> re. 42 � <br /> Gawaart ;mne we <br /> AWY LIGE <br /> 14T13lOfti . ST <br /> _ . . : +k <br /> ASBUWT DMKOAMW 4 MWNCM CAD 0 2 8 2 7 7 0 3 6 <br /> 7. Trans{n ren 2 cm z , �ar2 <br /> U.S. EPA ID Number <br /> 8. Designated Facility Name and Site Address 1 : S EPA n _ <br /> US ECOLOGY VERNON WC <br /> 5375 SOUTH BOYLE AVE110A <br /> LOS ANGELES CA 900M <br /> ir 32. <br /> 9: _ S ZkT Des=1Mx ratan. Ccs a cz lane -s.= ::1W c %Now 1 - <br /> F31 arc Paper[ x� € L� Mae <br /> NOWRCRA HAZARDOUS * STE. 901 KAU 90LKA~M FUMM -- -- - -- - - - — <br /> 0 <br /> DO III J� 0 . <br /> z = I <br /> u <br /> C] <br /> 14 . Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT : CHEMTREC 1-800-4244300 WOES TERMINAL CERES C3 NAERGN 981 : 171 * PROFILE 0981 : AP id if' <br /> I P'' `29A OILY SOLIMPAPER HLTERS * P50040050605 * APPROPRIATE PERSONAL PROTECT t1lE EQII"ENT <br /> 15. GENERATOR'SIOFFEROR'S CERTFXATION: 1 hereby decd ti � mo ,Zk ;F xrsg-er iiy a. r r3m= *� to Teas mre ac 3� ! <br /> marked and labeledrpiaca ded, and are in al respects in proper corcern 5_r tfaspor, a= dtg t acosra5e neiiiiia=ia arc ^i=~jcra x•+s-rma:raoiis f aev- ; ivre-r w c an 2-e }rsry <br /> F_lgorter, I certify that the contents of O s consigvrtalt conform to Ute tarts d L e a=adred EPA Aacn msg � :Jx- <br /> 1 certify that the waste nurixn¢abon statema-t Wangled in 40 CFR 26W(a) tg I aro a large q�ara# gang x 'ill f a- : s-at a wm 3a1F=2::r = Tole 1 <br /> GeneratceslOffeWs PriniedlTjped Name <br /> IL <br /> J 1 16. tional Shipments <br /> P-- ❑ Import to U.S. ❑ Export from U.S. Pat of er><ty;exrt <br /> z Transporter signature (for exports only): Date leaving U.S.: <br /> U V. TransporterAduiow dgment of Receipt of Materials tel? <br /> Transporter 1 PdntWfTyped Name Si fe �/ Month Da Year <br /> Twee_ L0 � � A� e1� ` tF ==�"� ( l <br /> ca <br /> zQ Transporter Printed/Typed Name Signature Month Day Year <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space ❑ Quantity ❑? Type j <br /> T e ❑ Residue El Rejection Full Rejection <br /> f <br /> Manifest Reference Number. <br /> 18b, Alternate Facility (or Generator) U.S. EPA ID Number <br /> J <br /> ' V <br /> Il Facility's Phone: <br /> LU 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> a <br /> Z <br /> y19. Hazardous Waste Report Management Methal Codes (Le', codes for hazardous waste treatment, disposal, and recycling systems) <br /> W 1 . 2. 3. 4, <br /> 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name { Signature Month Day Year <br /> EPA Form 8700-22 (Rev: 3 05) Previous editions are obsolete. DE61* TED FACILITY TO GENERATOR <br />