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Please print or,[ype.•(Form desigried.for use on elite (12 -pitch) typawri� UNIFORM NA2ARDOU8 1. Generator ID Number WASTE MANIFEST ' C A !. 0 0 0 2 5: 7' 6 2 7 5, Generator's Name;and Mailing Address `� ,:.r� t;ASRAl�` Ck�#3YSl.ER t'r1ESTERN MOTORS ='C • P.O. t3OX.2�,t36 • �}ANTECA CA Generators Phone: `?09 x'23 ��g • 6. Transporter 1 Com an Name ASsuR�r �t�VlRot�MENTAI. sl±RVtCES :'. �) .- Form Approved.OMB No.2050-0039 ;� 2. Page 1 of 3; Emergency Response Phone 4. Manifest Tracking Number - - Generator's Site.Address pf ditierent than mailing address) @07.1- p5336 1.1�� Vt►Yt�SEMITE AVE MA)VTECA •'' � Cly :95337 U.S: EPAID Number �i CAO02$27703G • 9. Designated Facility Name and Sfta Address U,S. EPA ID Number !1S ECOt_4GY VERNO(Y tFJC X378 SOtlTN BOYLE AVENUE ': l.OS ANGELfiS Cfi . 9005f3 CAD 0 9 7 0 3 O 9� 3 'aalil�sPhane: (323j277-2500 ga, . 9b. U.S. DO7 Dasuiption Including Proper Shipping Name, Hazard Class, ID Number, i0. Containers 11, Total 12. Unit 13. Waste Codes HM and Packing Group (ii any)) No, Type Quantity WtNol. 1• NON-RCRA HAZARDOUS M'ASTE, 5OLil3 (BRAKE !.ATNF SNAVtNGa^) �,, • 2$2 '�� ' 2. - • 14.5pedal Handling Insbuciions and Additional Information _ _ _.._-......—._._.__ Y_ -.....____....__..._.__-... _.�..----_..---_..__.. -_� ..-_.____ _.___�_—_.-_ _._._.� �� NIERGENCY CONiAC7 : CtiE!'�lTREO •1-Sf?0-424�3A0 NAERG�fi 901: X71 * F'ROFCI.E #� 98�.: AP19A255 BRAKE•iATNE:.�'._ •._ ; � .. ' . ' SHAVINGS * P500.000274«7. x APPROPR{A'il: PEFiSOAJAi. PROTECTIVE EQiJIPMENT _ i ;.% .. :. ;. :.... .: �. 15, , GENERATOR'S10FFEROR'S CERTIFICATION: I hereby dedare that the contents of this consignment ere fully and accurately described above by the proper shipping name, a:d ora dassified,packaged;-, •:..•. •_::�• marked and labeledlplacarded; and ora In ail respects in proper condition for transport according to applicable intemaHonaland national governmental regulation. I�xporisbi entand I am the P.rjmaN .:.�i ;�',� :":.: Exporter, i certify that the contents of this c0nslgnment conform to the terms of the attached EPAAcknowledgment at Consent. .�-� • I certify.ihat the waste mintmlzation statement Identliied In 40 CFR 262.27(a} (if I am a targe quaj?U generator) or (b a small quanfity generator) is true. Genefa' Of<eror'a��Prigqt N m Si natur �.. Mon Day Year. - � 16.IntematiOnalShipments �'"�----�^"•�� �.. - ❑ Import to U.S. ❑Export from U,S. Port of enbylexil: Z Transporter signature (for exports only):.. Data leaving U.S.: � 17: TransporterAcknovAedgmentbfReceipto(Materials ,_,.._---. • Trenspo r 1� dntedtt'yped e--• � Signature ..-�� Month Day. Year Q Transporter 2 Printadliyped Nama t_,Signafiire Mongr day Year , 18. Disuepancy ;18a. Discrepancy lndiption Spaco � puantity ❑Type ❑Residua ❑Partial Rejection ❑Full Rejection Manifast Reference Number. - 18b. Alternate Fadlity (or Generator) - U.S. EPA ID Number U .. Fadlitys Phone: Month Day Yaar � 180. Signature ofAltemate Fadlity (or Generator) Q 19. Hazardous Waste Rop/ort Management Method Codes I.e., codes for hazardous waste troatment,disposal, and reaydtng systems) 20. Designated (Fadlity Owner or Operator. Certification of receipt f hazardous materials covered by the manifest except asmded in !tern 18a ,�...� Pdntedlfyped Nama Signature �� Mogth Day ear EPA Form 8700-22 (Rev, 3-05) Previous editions are obsolete. 7 is SIGNATEp FACILITY TO. GENERATOR �. � '