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�- Iq 1855 boy <br /> Please print or type.(Form designed for use of,,elite 112-pueb)typewrilel.) Pon Approved.OMB No,2050-0039 <br /> UMFORMHAZARDOUS i.GenerolotIUNumber 2Page IW 3 Emergency Response Phone 4.MarIResT7rabhing Number <br /> WASTE MANIFEST CI1L9()9312G52 1 990-74&7449 0 00897725 G B F <br /> Gennato!s Hamo and rdaang AW05II Generator's Site Address(if dlflorem than mating address) <br /> AM-PM WOODBRIDGE <br /> 1 B806 N LOWER SACRAMENTO RD <br /> WOOOBRIDGE,CA 95209 <br /> uerkMCh Phgk-. 8 <br /> n Transporter I Company Name U.S.FPA ID Number <br /> SHOP HAZARDS SOLUTIONS,INC CAOOOD546497 <br /> i TFm%WP.r2Company Name U.S EPA ID Numler <br /> S.Dicualrri,ked Faulily Name ami Site Address GEM-RANCHO CORDOVA,LLC US EPAIDNumber <br /> 11555 WHITE ROCK RD. CADOOM163 <br /> RANCHO CORDOVA,CA 95742 <br /> FaphNs Pnas: 916-351-0980 <br /> all gb US.DOT Deacnpacr,pncludmg Fmper ShlpFung Name Hazard Cuts,On Number. 10 Cwlamea11.Trial12 Unit 13.warm Codes <br /> HM and PwAng Group ft acrd No Tvpa Quantity NANut <br /> Har7ARDOLIS WASTE SOUD,N.O.S.,9,UN3077,IB 1 OM 225 P D016 331 <br /> 0 (GASOUNE,BEN2FNE) <br /> z 2 <br /> W <br /> O <br /> 5 <br /> 'S.SPeoal Wmalm msnucaneann IFanal lnlarmahnry AD�i e.eA l � w1jU <br /> AP�PROPPRIIAATEPROTEC CLO H�N�af1� w �^ W�9 <br /> SEE ERG 0171 <br /> 15 GENERATOR'SIOFFEROWSCERTIFICAT10k I hereby derlare that the contents of Nik ronaignmem are furry and acw.'akty tkurArod above byme proporshpping name,and are desmhed.Packaged, <br /> marked arld labakdrpaurded,and are m all raspeGs to proper cdrvlibpn lar ulanspon accadruj m aPP1uabu imerreaonaland naaona:gtmmmpntal re3Walions lI expos snIPTPrd and I am the Prmrar} <br /> Exporter,I avdM that the cdnlnm of gas comegnmem conrerm to the terms of the attacked EPAAcanamedgmem of Consent. <br /> Icandy mat he xrask mnimrzaWn statement elendaaem 40 CFR 26[27(a1(rfI ame,large queen gentrabr)or(b)III ram a Small ga3M0 generamn IS Rue, <br /> 11 . <br /> Generale es FawdlEyped Now Signal Nand1 Day Year <br /> AN1 Syl fjo 1 7 2- <br /> �I IE Hkmauanal 5homems <br /> F �Im(rpn k U S. u Expert from U.S Pon of arm'ylenc <br /> Terepane•ngraarre Per egmns do h'1 Date leavng U.S. <br /> W I?LratgpimerA:kruvrmdgmenl of P.ecsq et MAlenma <br /> Tr r 1 Prole Ryaed Na7e sign nankin. qu <br /> O <br /> a <br /> U r P iy a ms "nature March Dry Year <br /> a <br /> I. yrrCiapaT.% <br /> IBA Dickepent,Indetan spa Ouanaty OT/pe ❑Residue ❑PurRAl crwradn ❑Full Rs!eclor, <br /> Manifest Referees Number: <br /> F IEb AIhhwle FarA'y(or Generaan U.S EFAID Number <br /> J <br /> U <br /> W Fatima Phone <br /> �{ lel ai immum N Nkrrak FANIIy 1N G6aerarprl <br /> N <br /> W mlla Day Year <br /> 2 <br /> HtS.Hazardous Waste Repod MarapeRanl Metlwd Codes ll.e..codes MNazardouswaste lreabnent,depoWl,argil rerydng aysteme) <br /> Wo 3. 4. <br /> j70.Cosigrmod PanuffyD..,N Opamle,0.nl6c!arnf:ecnpl of Muvdo.mayenele covered by the."feet c.pl as noted!n Item las <br /> l -Mm Typed Name Stinal ktonm Day Year <br /> EPA Fan 870E-22 Rev.3.05) Previous editions are obsofete. 2 3 _ . <br />