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Please print or type. (Foran designed form do elite (12 -path) typew iter.) <br />FO A ed M <br />ePA Form 87 - 2v 3-051 Prevto eddmns <br />DESIGNATED FACIJY TV DESTINATION STATE (IF REQUIRED) t. s <br />ns Pp" 0 8No.205X,03- <br />UNIFORMXAZARDOUS 1��^motor lD Number 2. Page lot 3. Emergenq Response Pnone a. Manfest Tracklrg Number <br />WASTEMANIFEST CAR000186668 1 0 368.4778 015349529 JJK <br />5. Ge1e2:ors Name one Ma" A mop, Gene2!WS$MALVresS (Ifiieerent Nan mailing address) <br />COM &UNITY FUELS 809-C 5NEOEKER AVE <br />809-C 5NEDEKERAVE <br />STOCKTON CA 95263 STOCKTON CA 95203 <br />Gere ilorsProne: 209466 -AM <br />6. Transporter 1 Compam Name U.S. EPAID Nmnbar <br />ENVIROSERV CAR 0 Q 018 8 2 01 <br />i. imnsporter2 Compary Nam � US. EPA ID Number <br />V <br />ntnn <br />6. Designated FwMy Name and Sae Address U.S. EPA ID Number <br />MNECO <br />1007 VULCAN ROAD- HASKELL <br />BENTON Aft 72615 <br />FW&Ys Phone: CMI)778-90,89 ARD 9 8 1 0 5 7 8 7 0 <br />9a. <br />9b. US. DOT Deaepeen Including Proper Shipping Name. H ssard Gass. W Number, <br />f0. ConlNrlers <br />11. Total <br />12. Unit <br />XM <br />arrd PacorVGmup(dsrtyp <br />Quantity <br />MJYV. <br />13. Mule Codes <br />No. <br />Type <br />o <br />X <br />1 UN2M, WA5TE FLAMMABLE LIQUID, CORROSNE, N.0.5.,3 (8), PG8 <br />,pF, <br />D0p1 <br />0002 <br />F003 <br />(METXANOL, POTASSIUM HYDROXIDE) <br />w <br />Ci O 1 <br />FDOS <br />213 <br />t7 <br />X <br />2 NA3077, HAZARDOUS WASTE 50LID, N.0.5,9, PGIII (METHANOL, <br />TOLUENE) <br />DIM <br />DM <br />500 <br />P <br />F003 <br />F006 <br />952 <br />3, <br />a <br />la. 5pedel Handl. g fnsepcdona and AECa1onN Imotrnnwm <br />98111008-11505-FLAMLIOUID-LABWA5TE OWSSPF ERGf7:9B1.132,902.171-ERSW.O.0122476-VA- <br />982)1008.11223-SOLID DEBRIS -LAB WASTE 2X55DM ' u SD <br />24 HR EMERGENCY CONTACT: ENVIR06ERV <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: Ihereby d"m Nat Na wntenb of Nia ca -s Sanest are fully and accurd!ey fterbed above by ele Groper shipping nam er and are OIWAed. padraged. <br />marked and USele&plaurded and are in as respects N proper cond:.icn for varepod scwrdrg b apPlicab!a intemationaland national governmental regulations. If export sNprnentand I am Ne Pnmary <br />Exporsr. I cer* &or the mnWes of Ne o rsgnment whom to the terms of the of EPAAcla mvledgment Of Consent. <br />I cetily Nat the Paste miram'valion datemenl Identked in 40 CFR 262 27(a) (i! 1 am a large quan:y, gemmetor) or (b) (il em a small quantity generabr) Is We. <br />Gralorvo-lems PrimeN , <br />b11 <br />Ony Yae <br />%YL- <br />vV-1, <br />2 "T/ <br />F <br />16. InteMacral Sh poewns <br />❑Importb US. ❑Expos hcm U.S. Podof enVylexg <br />Transporter signaNe(lcr exports Only): Date leaf - <br />w <br />17.7mresposterActmoMedgment of Recent of Materials <br />Fe <br />Trar 1 PnnwffvM <br />m Signeve, Marts Day Yaar <br />y <br />�FnC:� <br />b O' <br />TmnapoMr2PradeNfryed Name 6 <br />Monty Day Year <br />2 ZS /6 <br />16.Oauepancy -.. `. <br />Ise Dsaepan lndrzaaon Space ❑ Quantity ❑Typs' ❑RSF3da ❑ Partial Rejecaon ❑Fua RepC.- <br />reow Number <br />!So Altemial. facety (or Gensator) U.S. FPA ID Number <br />u <br />LL <br />FacEtysPhwc ENVIROMMENTAL <br />wrbc. <br />Signature OlAlemara Fadry(or Genemta) -_.. ... <br />AIonN Day your <br />r <br />4 <br />Z <br />S2 <br />19. Naaerdauy Waste Recast Management Meawd Cedas;ie., modes for haaandous waste mialmnl, dbposal, and recycling systems) <br />C <br />2. <br />7. <br />1 <br />20. Desgnakd aNdy Owner or Operator. CMifiatbn ore of hate <br />Ous materials coned by the manifest except as mieM1jn lam iia <br />1 <br />a <br />S al <br />Mo <br />ePA Form 87 - 2v 3-051 Prevto eddmns <br />DESIGNATED FACIJY TV DESTINATION STATE (IF REQUIRED) t. s <br />