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Please-prinfar:yr:.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.ManifestTracking Number <br /> WASTE MANIFEST CAL 0 0 018 2 6 4 6 1 (800)424-9300 014057515 JJ K <br /> 5.Gener11J?Wlarpe and Ma41u4§1ress Generator's Site Address(if different than mal(ing address) <br /> 730 S. BECKMAN RUAD <br /> LODI CA 95240 4715 N.WEST LANE MONTHLY BILLING <br /> Generator's Phonnce::�p 209952-1662 STOCKTON CA 95210 <br /> 6 TranspoASBURY-EyNVIRONMENTAL SERVICES U'S''GI�1 �18 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA iD Number <br /> EVOQUA WATER TECHNOLOGIES LLC <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 CAD097030993 <br /> Facility's Phone: (323)277-1500 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WtN01. <br /> 1 NON-RCRA HAZARDOUS WASTE,SOLID, (OILY SOLIDS-PAPER FILTERS 1 352 <br /> �a G D IVlav P <br /> z 2. <br /> w <br /> c� <br /> 3. <br /> 4, <br /> L <br /> 14.Special Handling Instructions and Additlonal Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 NAERG#9B1;171*PROFILE#961:AP 192210 OILY SOLIDS-PAPER <br /> FILTERS * *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT a0/ <br /> 15. GEN ERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are in all respects In proper condition for transport according to applicable International and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement Identified In 40 CFR 26�.27(a)(If I am a large quantity generator)or(b)(If I am a small quantity generator)Is true. <br /> GenefatoesWeror's PrintedrTyped Name Sklnatw��L,_— Month Day Year <br /> efif fl C a 170 <br /> 16.International ShipmenLY� El import to U.S. Export from U.S. Port of entrylexlt: <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> UJ 17.Transporter Acknowledgment of Receipt of Materials <br /> W Transp r 1 PrintedlTyped Signature Month Day Year <br /> CL a 3a /G <br /> Qransporler 2 PfintecUpped Name SigInature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility,(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> U_ Facility's Phone: <br /> w 18c Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> 0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1, / � 2. 3. 4. <br /> 20.Designated Facil(/ity Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PanledIT ed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05T Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />