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a. - <br /> *m' RECEI V ED *mo <br /> Pease DWnt or lYDe.tFonn desgned for use on elite(12-pltd1l typowri(erJ FOM Approved,OMB No.2060.0039 <br /> UNIFORM MAZAR00(15 1. realty ID Number 2,Page 1 of 3.EffedIpy Regmnee Phone d.UNUM TracKing Number <br /> WASTE.MANIFEST C 4D981690176 ^,se 1 1 559-297-0102 1 001f;13728 <br /> 5C toe.Name and Meileg PMress - GanareaMa Sue Adrese(I dMarent am rnming address) <br /> HOT TANK SUPPLY COMIYANY <br /> 10328&SIERRA 5694 R.CLM..TON <br /> CL0=CA 93619.9311 FRESNO-Ck 93727 <br /> Generotoh Phar: <br /> 6.Trarrporw 1 Conlpar y Nam U.S.EPA ID NuTdw <br /> HOT TANS SUPPLY COMPANY 0126. <br /> 7.Trargppoef 2 CWWy Nam - U. : ID Ntmber <br /> 8.DOVV.M Fadily Name and Sea Adrass 'U.S.EPA ID NWnyg . <br /> CHEMICAL WASTE MANAGEMENT,INC <br /> 35251 OLD SKYLINE RD, CATMO646117 <br /> KETTLEMM CITY,CA 93719 <br /> Fadi'Na PhI 559.306-9711 <br /> 5, go.U.$.DOT Description(including Proper SkppWg Name,Hazard Class,ID Nu I 90.Conminea 91.TOW 12.Unit 13.Ww Cadea <br /> HM aat Paduno Group fd any)) .. <br /> '.Ne, Typo 12=* 'WIIWL: <br /> o UN3087,ENVIRONMENTALLY HAZARDOUS SUESTANCE 431 <br /> LIQUID,N.0.5.(METAL CONTAMINATED SLUD04 9,PF III DY P <br /> W 2. <br /> o UN1261%CORROSIVE LIQUID, BASIC•IAIOPGA1dIG <br /> N.0.5-„ CKILDIMit LEAD,R.Pg!II TP ff <br /> a. <br /> 14:Spada!Handvg ImtrmflaM tNAddieonel In6rmalinn <br /> 9R 2 ER&I54tCba5011d2tod LGad)APite0l95 Meatier Crmlaaiag Sodium HT&Mde Metals. <br /> M,-hri34 Sinn Wa?r P!oten've EgtTinmmt WOPSOMH 01107e5 (_;Cf_7M PtnAl'#BQ5166, <br /> gal ERG*1711CMmudated L6adf4ucous BiEed Sludgy Coatiumg Metals <br /> 15. GENERATO31 <br /> R' FFEROR'$CERTe9LATpN: Thereby tlPclara a;fhe ol1lliS conSOrnentare,fUly and a=raWy desuhed above bytheproper shl*ng?name,and are dasared,pK'Qjsd, <br /> marked and labeled/placarded,end am h ell resDeus In pmper.,c d on for hanspogKwdirg to appliceMe htertetianalantl national governmental ragulat cns.tlexpal shgrnentand l as the Pnmmry <br /> Eponer,I Cerdfy that lbs mraen(e of Nk WnskJlmtent conform to the Nrme of the attached EPAAckrmuled7npnt O Consent. <br /> I cedry Nal the n6te micimwbon ahknrrat identified In 40 CFR 262.27(a)(H l am a lorge prutiq press"on(b)of l as,aamal guan6ty gmerabnj is arse. - <br /> GereretclWCFemfePnntedfypedNana. Signow Month Day- Yw.- <br /> aSan : I9 SO 13 <br /> 16.In�rtbnW r $hO II--FI ff-�y <br /> F LJlmpon to U.S. u&palfran-. , OenaylaxR <br /> � Trareporter signature(la axpoHaoNy): p <br /> 17.TrangpMwAcknoWstmeNOReoWd MebroN <br /> T e'.PdOed/rypad Name Sign' - Month Day 'Year <br /> a to 30 i3 <br /> Q Transpeorter2 PrhMdrtyped NallR'- - Mored .bey Year <br /> Pm <br /> .�T 18.Discrepancy <br /> 18z.Discrepancy fodiceeen Spare a Duentlb' LJ Type ❑ReWdr. ❑Penial RgICII06 ' ❑FOI Rejection <br /> yy Marilaet Refeterce NumAer. <br /> ' F iBb.Allemate Faddy lar Generator) U.S.EPA ID Numhar <br /> U <br /> aas. Fed'Ay's Phone: <br /> W 16c.Sgnitge ofWlemata Facilky(arGenemMrl <br /> z Moro Dw <br /> q19.HAI Waste Report Msrgement Method Codes(re.,c4o,$for Miardous modeoe yt ha it deposal,and moyding systems) . <br /> 2D.Detijn dFeeMly Owner.wpparagr.CerElMBWof uPtL.dfharerdauem:(edakcovered by Ne man6eel exceOas ndedrltam+ea <br /> yP Name ignaluaunnin <br /> .. <br /> FPA Folin 8700.22(Rev.3-05) Pawinui OdiliWls are obsolete, <br /> £ 'd £6b£ '°N ---^------ AMIISI0 Wd60: 1 £l0l '0£ '130 <br />