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Please lint or tylk.(Form dasi ned for use on elita Cj2-pftr4�)Vpajy�tar�) q <br /> Form Approved.OMB No,2050-0039 <br /> (INIFORMHAZARDoUs i.caneratorIONumber I-Page I d�3,Emergency Response Phow NuftiF— <br /> WASTE&IANIFr:ST r- A L 0 0 0 1 8 2 800) X4430130128 JJK <br /> -5--G—evA ZO <br /> 500 E KETTLFEWN RD. <br /> LODI , CA Ell 40 <br /> GeneraWs Phone: 209 Mg-M <br /> 6.Transporter 1 6;Ep—any Name U.S.EPA IU riuIDtar <br /> ASBURY EWRONWENTAL SERVICES <br /> C A D o ? 82 7 7 0 3 6 <br /> 1.Transporter 2 Company Itne U.S.FFA <br /> S.Desfgnaj%fn,1Sb dross U.S.EPA ID Number — <br /> 8 1 VEA% j WING. <br /> 5376 SC)LrFH BOYLE AVENUE <br /> LOS ANGELES CA SQQF58 K A D 0 : 7 0 j 0 9 9 5 <br /> radlitys Fbono; W aL;-'7 7-1-9 0 0 <br /> ge, 9b.U.&DDT Oescrip1an(includ4 FloapirSNpOG Nam,Hazard Nass,ID Number, Containers 11.TOW 12.Unit <br /> RM and Padang Group{if any)) No. Type Quantity WUVi,1. <br /> 13,Waste Codes <br /> at <br /> NON-RGRAHAZkRDOUS-WASTE;S0110 OILY SOLI OS) DM P <br /> :a! 2- <br /> &U <br /> RECEIVED <br /> OCT o6 2014 <br /> 4. <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENI <br /> 74—sped-81-Hauling MEN=and Adamal in5ndw <br /> ,r EIVERGENrGY GONTACT:CHEMTREC 1-800-424-9300 NAERG#961 171 PROFILE t 891 :APiTM OILY SOLiDS'PC# <br /> Al iOl 49065'!APPROPRIATE PERSONAL PRO TEUMVE EQU10FENT <br /> 71 L/?)2 <br /> 15. GENERATOMOFFEROR's CERTIFICATION:I hereby declare that the contents of ft consignment are fury and sccurat*described abom by the proper shipping none,wvJ am dissillad,packaged, <br /> marked and labeled/placarded,and are In all respects in proper coed ilon for transport according to apll=le lntafa el eW nhbmal gwemrmntal teguiallons.If mgmt shipment and I am the Primary <br /> Expwm,I cerfify that the contents of oris consgnmant comm to the Im of M allaeed EPA Adwalodgment of Comet <br /> I GeNly,ulat the wasto adw=50n statement ki-ribW In 40 CFR 26217(a)(it I am a WIja quantity generators or P(11 am a small quantity ganorslot)Is trio. <br /> ................... <br /> Intam2lional Shipments 11-11mpn 10 U.S. ❑Export fccm U.S. PCI of emfwdl: <br /> Twisporler signature(for opott onty): Date=saving U'S.; <br /> IX 17.TransportarP6=Medgment of Receipt of Malerflais <br /> U) <br /> Tra&porter2 Primo d?TypoVName Mon9l My year <br /> tor.D±stsapanof <br /> 15a.DimBpancy Indication Spam El Quantity E7- 7 Residue ❑Rqruai Rejection 7 Full Rejeciion <br /> Manifest Reference Number. <br /> 1W.AtternaTaFacgly(cwGweratoo U.S.EPA ID Number <br /> < FacAftYs Phoria: <br /> tee Slenstwe OfAlternato F.—.1ty w­5 Mwlh Day Year <br /> le.Ha4"ousVYastqRepast Management hie"Gwas(i.e.,wOes for hazardous waste treatment,dIsp=',and MCAN systems) <br /> LU <br /> 4. <br /> 20,136smamted h inar of n y manifest except as <br /> 9?emtorCeMmbnofreml.ptafh=w-dou3 tofatsthe m1vdhtV18a 111717 <br /> 'Mname -Slpawra month Day ear <br /> IMA corm 8700-22(Rev.a-06) PrIvious ed'6 ns are o aTe�e. DFSSIGNATE6� lLi�YYRiiTINATION STATE(IF REQUIRED) <br />