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017791687JJK <br /> Please print or type.(Form des ned for use on elite 12-pitch) er.) Form vod.OMB No.2056-0039 <br /> UNIFORM HAZARD= 1.Generaw IU Number 2.Page 1 of 3.Em many Response Phone 4. nttest <br /> WASTE NIANIFEST CAL 0 0 018 2 6 4 5 1 (800)424-9300 017791687 JJK <br /> b.0anergte[►11,sW014" drvea Generators Site Addrmv( different then malRng addrats) <br /> 500 E.KETTLEM22AN RR, <br /> LODI CA 95240 <br /> tor <br /> generas Phare: 2(393390900 <br /> 6.Transporter Company Name U.S. r <br /> ASBURY EWRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> 8-De9rgnated Fad➢1y Nemo and Site Address U.S.EPA ID Number <br /> US ECOLOGY VERNON INC <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 C A 0 0 9 7 0 3 0 9 9 3 <br /> Fedlil rs Phone: (323)277-1500 <br /> ga, 9b.U.S.DOT Desalptlon(indudtrp Proper Shlpptng Name,Hazard Cies,10 Number, 10.Canlainers 11.TOW V.Un t 13.Wasm Codes <br /> HM and Packing Group CK-y)) No. Type QwUty WLW <br /> 1. NON-RW HAZARDOUS WASTE,SOLID.(OILY PAPER FILTERS) 352 <br /> z 2. <br /> Lw <br /> ) <br /> 3 <br /> I <br /> a Ld <br /> 14 Special Ha-dinp lnstnxftm and Addil"i Wormalon <br /> EMERGENCY CONTACT:CHEMTREC 14WO.424-9300 NAERG*981:171*PROFILE N 9131:AP167298-1 OILY PAPER FILTERS <br /> *P'S06U0039757*APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT A q-6 I Ll <br /> I V'55 c5e <br /> 15. GEIIERATOR'SfOFFEROWS CERTIFICATION:I hereby declare Owl the contents d this camignr wdare Anlyard accurately desontW above by fire proper st*Vhg name,and are dasW6ed,padLapd. <br /> marked and Wbei"placarded.and am in s4 respects In props aw4tlon for Wn4ort socudN io appGwbb inImnaboml and rwomf govemmen al regulations.M export shornerd and I am th PArttary <br /> Exporter.I ox*that the mrdenls of this oornfprsmrR conform b,the temp of the alWdred EPAAdmo*Wgmerd of Consent- <br /> I certify Ing the waste midmtzaticn statermnl ioorrbfied to 40 CM 26227{a)(d 1 am a targe quantity generator)or(b)of I am a snmll quantity gormra"is true. <br /> GrstC stmmrsPdreedrryped amo Monty Yea <br /> Day Ye <br /> CO <br /> 1 irrpat b U.S. ❑Export f rn IJ.S. Port of w ftfedk <br /> z Trarsporte,sipmuna(for evats aey): Dale ba4v U.S.: <br /> '17 TrardporkxAdaroafedgmerdofRao*dMaim" <br /> a T 1 Printefypol NameSgrwfure Monty Day Year <br /> p f7 <br /> ZsC AM- <br /> Transporter 2 PrinteffTyr NaM- ${posture Month Day Year <br /> R' <br /> h <br /> 18.Dlsarepancy <br /> 18a,Discrepancy Indication Space ❑ Qusntiy ❑Type ❑Rosdue ❑Partial Rejection ❑FW Re)ectlon <br /> Mentfest Rekrarca Nwnber <br /> 18b.Ahemate Fadity(a Gemratcr) U.S.EPA 10 Number <br /> U <br /> LL tacwfi Phone: <br /> 18c.Signahxe of Alrenrwte F"ty in,Genera(or) Monin Dap Year <br /> ig 1g.Hazardous Waste Repw Management Method Codes p.e.,codes for hazardous waste tr"M em,disposal.and recycling systems) <br /> 0 1. 2. 3. 4. <br /> 20 Designated Facility Owner or tor.Certification of moolpt of hazardous materials covered by dre manliest azcept as noted in nem 18a <br /> .oboe / Mundt Day Year <br /> EPA Form 8700-22(Rey.3.65) Previous eddionsamobsolete DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />