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Please print or Nce. (Form lesioned for use on elle (12 -Ditch) typewriter.) <br />Form ADoroved. OMB No. 250-0039 <br />* <br />UNIFORM HAZARDOUS 1. GeneratorlD Number <br />2. Page 1 of <br />3. Emergency Response Phone <br />4. Manifest Tracking Number <br />WASTE MANIFEST C A. 8 0 0 0 18 6 6 6 8 <br />1 <br />()300)()300)368-4778 <br />016162439 JJ K <br />5. Generators Name and Mailing Address Generators Site Address If different than mailing address) <br />COMAUNITY FUELS L009 -C 5NEDEKER AVE <br />_ <br />80&C 5NEDEKER AVE <br />STOCKTON CA 95203 STOCKTON CA 95203 <br />Generators Phone: 2019 4 68-4 823 <br />6, Transponer 1 Company Name U.S. EPA ID Number <br />EMdIRO5ERJ CAR000186201 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />TRAN5CHEM ENVIF01-4NENTAL A Z D 9 8 2 4 8 4 6 7 8 <br />8. Designated Facility Name and Site Address U.S. EPA ID Number <br />WNECO <br />1007 VULCAN ROAD -HASKELL <br />UENTON - AR 72015 <br />Fa oliys Phone: (@O1)776-9089 IA R D 9 8 10 5 7 8 1 0 <br />ga, <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Clan, ID Number, <br />10. Containers <br />11, Total <br />12, Unit <br />HM <br />and Pedung Group (it any)) <br />Quantity <br />WINoI, <br />13. Waste Codes <br />Na. <br />Type <br />L UW,,A W.k5TE FLANWOLE LIQUID, CORRO`FVE, N-O.S, 3 (8), PGII <br />DWI D002 ,_µ: <br />X <br />OAS T HANOL, POTASSIUM HYDROXIDE) <br />DF�J <br />G <br />213 - <br />2. UN1992, WASTE FLAMMABLE LIQUID, TOXIC, N.O.S, 315.1), PGII <br />X01 <br />X <br />(MET?tANOL, CHLOROFORM] <br />D F <br />5-- <br />� <br />- --- <br />551 <br />X <br />3- NA3077, HAZ7tRDOUS WASTE SOLID, N.0.5, 9, k f r' <br />�,.,%'.-.�.f ` <br />1�..1 <br />7/'-) <br />F� r:� - - <br />TOLUENE)` w <br />H'F <br />�nn <br />o� 0 <br />P <br />-..... <br />4. 0 2 Z016 <br />`trill/ <br />14. Special Handling Instructions end Additional Information <br />9@?11008-11505-FLAMLIQUID-LAB WASTE 1)c�S",[ifr }'1RTIAENT ERG#:9@1. 132, 9@2. 128, 9B3. 171"ER5W.O.#?23433-EC8 <br />962)1209.07017 - LAS SOLVENTS I n 9-9F » <br />( <br />9B3)1008-11223 - 50LID DEBRIS- IAB WASTE7.�C. j $Off% • <br />24 HR EMERGENCY CONTACT. ENVIROSERV <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately descnbed above by the proper shipping name, and are classified. packaget. <br />marked and labeled/placarded, and are in all respects in proper condition for monsoon according to applicable international and national govemmental 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 EPAAcknowledgment of Consent. <br />1 certify that the waste minim¢a6on statement identified in 40 CFR 262,27(a) (it I am a large quantity generator) or (b) If I am Wmall quantity generator) is true. <br />Generaws106e m's Prirrtedrryped Nacre Signature Month Dav Year <br />F <br />16, International Shipments <br />El Import to U.S. ❑Export from U.S.Pon of entryiexii: <br />= <br />_ <br />Transporter signature (for experts only): L11 Date leaving U.S.: <br />W <br />17. Tansporter Acknowledgment of Receipt Materials <br />Transpo � Primedfryci N Signature Mlnrlh Day Year <br />i <br />N <br />8 / <br />iQ <br />7d. <br />TmnjMrmnewiypedv;rme SignaNre MonthDaY Year <br />D'screpan y <br />I18. <br />18s. Discrepancy Indication Space ❑ Quantity �� Ty,e LJ Residue ❑ Partial Rejection ❑ Ful Rejection <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />7 <br />U <br />LL <br />Faciliys Phone: <br />18c-Sgnefurc ofAllemate Facility (or Gerroaor) Month Day Year <br />a <br />Z <br />19. Hazardous Waste Report Management Method Codes pe., codes for haramous waste treatment, disposal, and recycling systems) - <br />2 3. <br />4, <br />20. Designated Facility Owner or Operator. Certification of receipt of hazamous materials covered by the manifest except as noted in Item 18a <br />Pnn ytaed Name Signature Month Day Year <br />��r, v.... v, vv u Mev. rva7 nevruua emuvna are uusmene. <br />