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• • <br /> Please print or type. Form designedd for use on elite(12-pitch)typermter.) Form Approved.OMB No.205P0039 <br /> 1.Garraab IO Numba 2.Ps9s t d 3.EnreW"Resp m Phone 414arrfM Tncatp Hadar <br /> uNB,SIE.►WF 5 CAL000367739h 1 :. am42+-m 010197567 JJK <br /> 5.Geraraar's Name and Maitn9 � Geoxafors She ndmeaa(8081119"1 than mailn9 address, <br /> QUICK TRUCK REPAIR <br /> 1950 E MINER AVE <br /> STOCKTON CA 95205 .. <br /> RawaMePhae: I n 5 5 7 - U.S.BA—U)Number <br /> S Trasparter 1 Cmwary Nana <br /> FREMOUWENVIRONMENTAL SERVICES INC, LS.AA,0 0.0 •1 7,1 0.1 7 <br /> 7.Transporter 2 Canpary Nan11 U.S.EPA ID NWW <br /> WORLDWIDE RECOVERY SYSTEM INC Mr LC,,AeR,0 <br /> .. S.Datigsead Fatlky Nems,aro SlmAddresa U.S.EPA ID Hunter <br /> US ECOLOGY INC AH„ <br /> HWY 9511MI S OF CC 16 ACRES,: <br /> . BEATTY W 89003 f .. a <br /> Phma ;Ta 3 0 0.:1 .- 0 0 <br /> ga gb.U.S.DOT DesmpBm(houdsrg Proper Strpping Name,Hazard Class.m Number, 10.Carmerere .11.Tda 12,Urn 13.Waste Codes <br /> HM and Patldrg Gm11p(d aoyN No. Type 'Ouanay WWd. <br /> Iz NON-RCRA FUi7ARDOUS WASTE.LIQUIDS(CILY SLUDGE):m I ., <br /> h �T <br /> 343 <br /> W 2 <br /> 3. y <br /> 4. 1 <br /> a.spe"HWAINk,atacemeana hmnnabW J#01013I. SkxlpERG#171:t <br /> zlxssg <br /> .,.$A%MIZRSTGBE40OLTRAR4EDAND tMEPPB.... <br /> 15 0&IERATOR'SIOFTEROR'SCERTWAT10N: IhaaM cedars tlretme mnbnla Mtlue mnsi9nment aefiAlY arc acwra�f M'�NoVa s69dnB tee,ad as,cFeaaAed,pacMa9&l. <br /> marw and mbaerLlplecaded,ail as,h al respells tn popper mrnF m Na trmsWrt amrdeg to ap*ade inbmetiooelard retlonal 9msrtmartal mg tgsorw.Neopat stWmmn and i am the Pantry <br /> E>Paler,l oertfythal dre mnnmM of#n mnsignment Canham b ria amre d the abct*d EPAA&WMadgrbntd Cmsmt <br /> I mrtty srdNe wage nrrrni'vatlan stdarontdma8edh40 CFR 28227(e)lNlematergeWmer'/gawrabx)a(b (Nl amasmal QuanNy gawamr)mtrue. <br /> p <br /> re Month Day Y�r <br /> Name D E R �1 d iL. steL 1 13 <br /> Zi I& Elftm m U.S. ❑EgrodNan U.S. Pan of ardryhdt <br /> Dansvorh etgnahsa(fa espora tinny _ Dam beveq UA: <br /> 17.Tramponer Admov Wpnnee�m('oof Receipt of Maerf9ls <br /> O Tznspcderl <br /> P tv&Typed <br /> G 09y Tea <br /> >, <br /> C `{ ili 13 <br /> Marts oar near <br /> Transporter 2 PmmO?yped Nene Signa <br /> `�0.w �� b I <br /> i18.Diauapatcy' <br /> 18a.Discrepancy bdioam Space ❑ Oaartlty ❑Typo ❑Read. ❑PaNa Rated. ❑FuN Rejection <br /> Madfea R11henm NaMer: <br /> 18b.ANaram Fac"(a Genaeta) U.S.EPA ID Nwnber <br /> V <br /> sora. FacWs phone: Monte Day Yea <br /> W <br /> 18,Sombae dAltemae Facility is Generdtal <br /> 2 <br /> 0P&ftdffypNd <br /> pot Managensrd Medal Cotler pe,mdesia tmzadas waste aeambnl tlisposd,ane negdag syatars) <br /> 2. 3. 4.aGDsramr ofmcWofN�rdos materials covered bythemaaese esspnas dodo Nem l8a dry(]Slg'�'re . Month I Y. <br /> 3 <br /> FPA Form8700-22(Raw,JH) PreviamedMonsare DESIGNATED FA41LITY 1 1LITYTODES ATIONSTATE IF REQUIRED) <br />