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Please print or type,(Form designed for use on elite(12-pitch)typewriter] Form Approved.OMB No.2050-0439 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Afanlfeat Tracking Number WASTE MANIFE5T .�G }C 3 G 4' 1 1800)424-9300 016769412 JJ K 6.Generator's Name and Mailing Address Generator's Site Address(if diRerant than mailing address) Q AND M. DSA TRACY CHEVROLET- Q.AN001 ?4'00 ',UTO PLAZA WAY TP,AI"Y CA 95304 Gmeratars Phone: 209 835-4500 5.Transposer 1 any Name U.S.EPA 10 Number WORLD IL ENVIPCNh1ENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 7.Transporter 2 Company Name U.S.EPA ID Number 8.Desiatsd Factiy Name and Sits Address U.S.EPA IU Number US ECOLOGY VERNON IrJC 5375 SOUTH BOYLE AVENUE LOS ANGELES CA 90056 Facility's Phone: (323)277-1500 t A U ]9 7 Q U 9 3 9 3 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit HM and Packing Group(d arty)} 13.Waste Codes Nc. Type Quantity WtNol. I N01RA HAZARDOUS WASTE. SOIL€D(BRAKE LATHE SHA,,IiNti7 181 P Z 2. 3. 4. 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT CHI--V7REC i SOJ•12q.9 CG i:':E T :,'. 4 L. ' J'1 'PROFILE#9151. 601528 BRAKE LATHE SHAW[' G5 PSU,v-Gva i Fr r' ',.i T i 15. GENERATOR'SIOFFERt]R'SCERTIFICATION: I hereby declare that the cnntenls of this oonsignme fatty and accurately described above by to-per shipping name,and are classified.packaged. marked and labdedlplacarded,and are in all respects in proper eondit on for transport aocarding licahle intematiorml and national govemmen ulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment confa m to the terms of the attached EP cknoMedgment of Consent. cartifythal n 40 FR 2fi2. (if I am a la uanlity generator}or(h}(iTi am a small q rator)is true - Generatorsl0lferors PrintedlTyped Name Signature Month Day Year 1.� 6.International Shipments i rt to U.S. ❑'no".U S. art of trylexit: Transporter signature(for exports only): Da eaving U.S.: Lw 17.TransportorAcknowledgment of Receipt of Materials Tran 1 Priftledtyped Name Signature Month Day Year Q Transporter 2 Pnnte*Typed Name Signature Month Day Year fY H 18.Discrepancy 16a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Reyaclion Manifest Reference Number. 16h.Altemate Facility(or Generator) U.S.EPA ID Number V L Fackilys Phone: H18c.Signature of Alternate Facility(or Generator) Month Day Year Z 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) LLJ 1. 2. 3. 4. 20.Designated Facility Owrrer or Operator.dertification of receipt of hazardous materiaks covered by the manifest except as noted in Item 16a Pdntedrryped Name Signature Month Day Year 1 2W12 AL se4107 cid 10/ I zD EPA Form 8700-22(Rev. 5) Previous ed!tons are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)