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Please print or type. (Form designed for use on elite 12-pitch) typewriter.) Form Approved. OMB No. 20SH039 UNIFORM HAZARDOUS 1 • Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 3 8 5 0 0 3 1 (800) 4249300 014051492 JJ K 5. Generators Name and Mailing Address Generator's Site Address (if different than mailing address) PREMIER CHRYSLER DODGE JEEP RAM OF TRACY PRE14i 3460 NAGLEE ROAD TRACY CA 95304 Generators Phone: 209 8204815 6. Transporter 1 Company Name U.S. EPA ID Number ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 7, Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number US ECOLOGY VERNON iNG 5375 SOUTH * BOYLE AVENUE LOS ANGELES CA 90058 CAD 097030993 Facility's Phone: 323 2774500 ga, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Gass, ID Number, 10. Containers 11 . Total 12. Unit 13. Waste Codes HM and Packing Group (deny)) No. Type Quantity WIJVoi. 1 . NON- RCRA HAZARDOUS WASTE. SOLID (OILY SOLIDS, PAPER FILTER )) 352 0 D (�v P z 2 w 0 3; 4. 14. Special Handling instructions and Additional Information EMERGENCY CONTACT : CHEMTREC 1.8004249300 NAERG# 961 : 171 * PROFILE # 9131 : AP200890 OILY SOLIDS, PAPER FILTERS * P500-00026858 * APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT �/' n ?I / 1 15, GENERATORWOFFEROR'S CERTIFICATION: i hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are cas0ed, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of gonsents I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or V(q I am a small quantity generator) is true. r toes/Offeroes Pdnted/Typed Na % Month Day Year • 5 J � 1�A Sign re J 16. Intemational Shipments t; ❑ import to U.S. ❑ Export from U.S. Port of entrylexit Z Transporter signature (for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials Trans 1 Printed/Typed Name Signature Month Day Year a , 4 ` d I Qrensporter 2 Printed/Typed Name nature Month Day Year t� t•- 18. Discrepancy 18s. Discrepancy Indication Space quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number. 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U W Facility's Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day Year a Z ' N19, Hazardous Waste Report Management Method Codes (Le., codes for hazardous waste treatment, disposal, and reading systems) 2. 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Prinlecirryped Name f- -- Signature Month Day Year G ti k5al I I leP5 I a EPA Form 8700.22 (Rev. M5) Previous editions are obsolete. DESIGNATED FACIJfYTO DESTINATION STATE (IF REQUIRED)