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`"� a l v Litt 3&( L/ Form Appmved.OMB No.2050-0039 <br /> Please pmt Or type (Form a ' for r3e on'g6te(J2�pifi t) 'ten) <br /> UNIFORM HA7ARDOUS- I � '�� " 2.Page lof 3.Fmergenry Response Phone a.M;nlh3t T�cyLngyprypet �� FLE <br /> WASTE MANIFEST rcuaoo218288 208-7128!130 0 o LV: SV2 LJ'LJ 9 <br /> S.GenaaersNamoaRtl inp Atldress 4,;;... '',. Generelore Sire Acoress(a ddhmN dun maUnp eadreasj <br /> ,'k = INDEPENDENT TRUCKING <br /> 1115 W CHARTER WAY <br /> .GTOCKTON,CA 852011 <br /> rtt Genrraa'splme209.46.8.5192Y05, <br /> e — U.S.EPAIDNumbar <br /> ; _ W %IMERIC%1N VALLEY WASTE OIL,INC. CALOOO8ZW8 <br /> T Tra�- Gnyge t d U.S.EPAIDNumber <br /> 2I tCenL u nv�ron Of eaG rniq LP MKOD0 POW <br /> e „k: 'Sal Mann epi-'215r CEawy EwR ENTALwmonam4 a U.S.EPA 111 Number NVD980885338 <br /> 2085NEWLANDS DR.EAST <br /> FERNLEY,NV 69408 <br /> P' l�iofra 775.57�ZJ �ir. . <br /> UpFS"100 ` F� P)ppa$Id{gargNarre,NamdClass,ID Normal, le Containms 11.7cial 12.UN1 17.Waste Codes <br /> NM Mdla�b b rsr :f.. . No. TYPe Quantity WiNul. <br /> MECI .:�s 223 <br /> �d,"�NON•RCRI4F�W.ARDOUS WASTE SOLID 1 DM (2 � F <br /> . �wasoNtitnlna:acNL - <br /> 4 SEP 14 2015 <br /> '' <br /> EN IRO MEN AL <br /> "02TW17.1 <br /> imburJlosDACTRAQ <br /> andAddiiautlydomuton <br /> �,. .YGR28746'1� EMERGENCY CONTACT:DAVE CARMICHAEL <br /> 15.1.GENERATORSIOFFERORS CERTIFICATION: thembydeciam that are mnlerJs of ft consignment are fully and accurately described above by the proper shipp6p name,and are dasslfed.packaged, <br /> Ier lan(I>evlyedb�ararded and are to all respects a pruperconel or fervent according towicable murnaea"ane " <br /> e an govemrtpNal regulators.If expert shinnerd"I an du Penury <br /> y'dulpa mritena-W tlrs mnib nl mnfprrnb tee tams of lire adadred EPAAwomedgmem at Consent. <br /> I.aeMy dbt�tlra,wdsie nuam7etion stile coin dOCFR <br /> 262.27(a)IV l em alarge evantiy,gemratorla@)(dlemarae quantity is me. <br /> ' ' yped are re y ear <br /> `s (v a 3 <br /> J 16. ate <br /> -U.S. ❑Expaiean U.S. Par o/enhyleidt: <br /> = Trans ore DOW Laying U.S.: <br /> l7.Transporter AdmpwIMgnenl of Receipt N Matmiale <br /> � T Mr1 ,ypad.N prate ns ay car <br /> S Q UI O <br /> TrialPrvfreQlf .re onN <br /> bay r <br /> T{/x I I IDI 113 <br /> * 18.Diaoeparcy <br /> 18a.QSCel Indrcabpn Space ❑ OtenNy ❑Type ❑Residue El Partial Rejection ❑Full Rejection <br /> MaTVsol Refererce Number. <br /> 180.Anernste Fack for Generelor) U.S.EPA ID Number <br /> J <br /> Q <br /> W Fapi sPhone: <br /> W 18a.sprraoreef Allawh Faddy for Gemnhrl Mala Day Year <br /> 2 <br /> 78.Hazardcos Report Marugamnl McMoa Codes(re.,poll for lwardae waste peatrmnl disposal.and recydng Mler:u) <br /> p7. / 2. 3. 4. .. <br /> 20.Deslguted FeriyOwmr Or Operator.Cersdoaond MOW of hazardous m mons mored by diem nrfW except es.Ked In bon 183 <br /> PsWeMyped Nana S,gralum M7 1 Dr T <br /> EPA FOTM 13700.22(Rev.3-05) Previous editions areTr1le1. .3-1 3A10: 36 I'M DESI N TED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />