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Please' not or t corm desi ned Tor use on elite 12- itch t ewriter, Form Approved.OMB No.2050.0039 Print type. 9 ( p ) YP. r 1 Generator ID Number 2.Page 1 of 3.Fmergency Response Phone 4.Manifest Tracking Number U�IIFORt+1 AAR -e :W.A- 'HAZARDOUS CAL00029�4439 � (,800)42493 �� JAS;GeneratorsName and Malhng Address ^•'Generators Site'Address(if different than mailing address) 0PY-1 UOE*1.478 1.648 E.HAMMER LN, STOCKTON CA 95210 20 1 Generator's Phone: �a,'fs52 87hG 6.TransponerYiCodipany'Name• '' "'" _' � `r:l•Jt"r �k1.S.1EPJCID , . ASBURY ENVIROWENTAL SERVICES r..)hh Ulu le h nt AL"O'A b 0 2 8 21 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 CVOQUA WATER TECHNOLOGIES LLC• 5375 SOUTH BOYLE AVENUE L:aa`ao a',•r„ . , ,, Fadiib/sPhone:r' r,. 3�$ 7T�150t4 ,... ;�. (;�.14,1�.Q;,`g 7,:4.3{�;r.3:9;3 LOS ANGELES CA 90058 9a, 9t.U.S.DOT Des Picon c'udin Proper.Shipping Name,Haza rd Class,ID Numher 10.Cpntalners,_,•:i r, ,u.11.Talai l .12:iUnit c: tint 13::Waste Codes HM and Packing Group(if any)) No• Duandty Wt.Not. �-' N��>t Rc a r�A ARflous WASTE ,":*LID,'(BRAkE IATWF'$t�f��l�Nd3) W I, L r -a L•! .21r„f,IIN..r; rib a I. . 'Z 2. o vynr;•`ter^n$r nol Q' t:' I W 3. •4. 14:Special Handling Instructions and Addlional Information J'• r EMERGENCY CONTACT:CHEWREC 1-8004249300 NAERGO 961:171 �rPROFILE4 961:P20742513RAKE LATNE SHAVINGS r PON AU0225791*APPROPRIATE'fPERSONAL PROTECTIVE EQUIPMENT 15. GENERAT01111OFFEROR'S CERTIFICATIONi I hereby declare that the contents of this consignment are fully and acc;:raie:y described above by the proper shipping name,aid are classified,packaged, marked and lati ed(placarded,and are In all respects In proper condition for transport according to app?icable international and national governmental regul2tions.If expok shipment and I am the;Primary EOorler,l corny.that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent I certify that the waste minimization statement identified in 40 CFR 262.27(a)(If I am a large quantity generator)or(b)(if I am a small quantity generator)Is true. enerator's Oerpr's PrintedfT4ypeName Si arare Month . Day Year. 16.International:Shipments F-. ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leavingU.S.: 17.Transporter Acknowledgment of Receipt of Materials Tranporter 1(� Pdrttedffyped-Name r Signature ... Monte f�ay-�- y0r.- . � t' 1. - r ^`�r�r f "'-` ��,..^�a?;. .."'u+bt'- r.+n.,•�....,.r -., . , '.�� -; � .{'? /•r.�•fj�f.... Fes•} •r(•"Y�.6'/.✓�,.rt'..�'�. ,,.,•r:.'s�.. zQ Trar#pdrtdr..2 Pfintedrryped Name ”-"Signature •'Month Day_ Year F-- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Ouanllty ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V ' LL FaciliVs Phone: LU 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z NIS.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) UJ L 2. 3. a. 20.Designated Facility Owner or Operator.CeNca11on of receipt of hazardous matedals covered by the manifest except as noted In Item 1 a Prat dfTypedName Signature Month Day :'Year EPA Form 8700-22(Rev:3-05) Previous editions are obsolete. TRANSPORTER'S COPY