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GITq- 00618- 1856 <br /> Please print or type.(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 PMrre 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL�6412 1 904424-9300-CHEMTREC 0 0 0 3 0112 5 G B F <br /> 5.Generators Name and Mailing Address GenamtorS Site Address(if different than mailing address) <br /> MCNEILUS TRUCK&MAII <br /> 3100 N AD ART <br /> STOCKTON.CA 95215 <br /> Generators Phone: 2094-3i-4-AK-151 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> FREMOUW EWRONM'cNTAL SERVICES INC. Phone£39 553-6274 CAR=17iOi7 <br /> 7.Transporter 2 Company Name U.S.F AID Number <br /> 8.Designated Facility Name and See Address U.S.EPA ID Number <br /> GcM Rancho Cordoba LLC - CA0980884183 <br /> 1165.5 White ROCK Road <br /> Rancho C9fdOva.CA 95742 USA <br /> Faa1hys Phone: 916351-fi�D <br /> ga go U.S.DOT Desoipbon(induding Proper Shipping Name,Hazard Claw ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM andPackurg Group(ifany)) No. Type Quantity WtNnl. <br /> 1_ Waste Aerosols,(Flammable,(each not exceeding 1 L Capacity)),2.1, DM Q n P A01 331 <br /> 0 UNI950,PG01 00 L si v <br /> z 2. Non-RCRA Hazardous Waste Solid(Oily Debts) 6 V I OM P 223 3552 <br /> � V66 <br /> 3. / <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> ALL HANDLERS TO BE 40 HR TRAINED AND WEAR PPE <br /> 9b1) R1198`[ ERG#126 <br /> 9b2) R 16935 ERG#171 tui Q 7::6 tgou3l <br /> 15. GENERATOR'SN)FFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment am fully and accurately described above by the proper Shipping name.and are damilied,packaged, <br /> marked and IabelSNplacarded,and are in all respects in proper condition for transport according to applicable intemational and national govemmenal 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 EPAAdmowtedgment of Cornent "Z'1;- <br /> I certify that the waste ranimbation statement identified in 40 CFR 262.21(a)(e I am a large quiudly generator)or(b)(ul am a small quantity generator)is We. <br /> Generator'Wereror teNT Name 5omatum Month Day Year <br /> liI l Srz� <br /> .16112 L;!14/5mz <br /> F 16,Intemadonal Shipments <br /> ❑Import toI.S. ❑Expat from U.S. P of emrylexic <br /> = Transporter signature(for exports only): Dae leaving U .: <br /> m 17.TransporterAckraMedgment of Race'npt of Materials <br /> Transporter 1 PrinleNT � <br /> Month Day Year <br /> QTransporter 2 Pdn%dTyped Name lure Month Day Year <br /> K <br /> f <br /> 1 180 Discrepancy <br /> 18a.Disoepancy Indication Spare ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Mandell Relerena Number <br /> 180.Alternate Facility(a Generator) U.S.EPA ID Number <br /> 7 <br /> U <br /> u Fadiys Phone: <br /> Maj 1&.Signature of Alternate Facility(or Generator) Month Day Year <br /> z <br /> w19.HaraNcus Waste Report Management Method Codes(i.e.,codes kc ruvarears walla treatment disposal,and recy'Lrg systems) <br /> WV I 1 •\�Designated2 3. <br /> 4. <br /> 1 <br /> � <br /> 20.Designated Facility Owner or Operator:Cer s ow of receipt of hazardous matenials covered by the manexcept as nand N Item <br /> 1 <br /> ft <br /> ntedRyped Name _77 Signa Man h Day Yeaz <br /> enS 2A <br /> EPA Form 870422(Rev.3-05) Prevbus editions are obsolete. <br /> ti, 10343.1675 DESI TED FACILITY TO DESTINATION STATE SOF REQUIRED) <br />