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,%W <br />Please print or type. (Form designed for use on elite (12•pitch) typewriter.) <br />M <br />_ ESIGNkTE:7 FS-:LtTafTC a?ESTINXiION fis','a' <br />rmwnPProvea. UMd NO. 2VaWUJ9 <br />t. Generator ID Number 2. Pa <br />UNIFORM HAZARDOUS 9e i of 3. Emergenq Response Phone /. Manifest Tracking Number <br />WASTE MANIFEST C A F. 0 0 0 +. $ 6 6 6 1 f3�1tI� 369-47-8 016162440 JJ K <br />CONMI FUEL�3 'AddressGenerators Site Address In ddferent Nan MIMS address) <br />209-C 5NEDEKER AVE E10 -C SNEDEKER AVE <br />STOCKTON CA. 9S21s STOCKTON CA 952M <br />Generators Phone 2M 466-4625 <br />6. Transporter Company Name <br />U.S,EPA ID Number <br />EMYIROSERd CAR000188201 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />6 D"IM-NVINVIMMENT U.S. EPA ID Number <br />35251 OLD SKYLINE RD. <br />KETTLEIMN CITY' CA $3239 <br />Fadr a Phone: i`91366-9711 CAT 0 0 0 6 4 6 1 1 7 <br />ga. <br />9b. U.S. DOT Description (including Proper Shipping Name, Haurd Class, ID Number, <br />D. Corti inem <br />HM <br />and Packing Group (d anY)) <br />11. Total <br />Quantity <br />12. Unit�No. <br />Wt No. <br />13. Waste Cedes <br />Type <br />1. NON RCRA HAZARDOUS WASTE, 50LID (DEBRIS, TRACE BIODIESEL) <br />o <br />352 <br />-_ <br />w <br />DM <br />ZI00 <br />P <br />z <br />w <br />_333_3. 3333. <br />3 <br />L <br />14. Spedai Haotll'ng In�s�uu�G�ions and Additional lnformabon <br />9611 CA - IEBRI5-DRAiNED FiLTER5 Vit? OIL. BIODS5EL <br />ERG4f:961. 171 "ER5W.O.ft129406-EC8— <br />24 MR ENERGENCY CONTACT: ENVIR05ERY <br />15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignmentare tully end ac mmrY described above by the proper shipping name, and are classified, packaged, <br />marked and labeled/ptacarded, and are in all respects m proper condition for transport according <br />w applicable intemabonal and national governmental reg,14100 s. H export shipment and I am the Pr inaD- <br />Exponer, I ceNfy that the contents of this consignment conform to the him of the attached EPA Acknowledgment of Consent. <br />I certify Nat the waste minimization statement idenpfied in 49 CFR 262.27(a) (d I am a large quantity generator) or (b) (ifl am a small quantity generator) is We. <br />Genereftb`S/Oflemes Printed/Typed Signature <br />-Dy <br />�N�am�e / p Monty( Y., <br />'6� L - na✓ o <br />mm <br />F <br />16. us `� 1 <br />❑ Import to U.S. LJ Export from U.S. <br />LJ <br />_ <br />Port of /exit: <br />Transporter signature (for exports Doty): <br />w <br />Date leaving U.S. <br />17.Trans rAUvwwkdgment of Receip[ol lariats <br />re <br />Tra spo Printed ped Na e <br />Signature <br />a <br />QTran <br />/ Monty Day Year <br />.e <br />yped Name _ <br />¢ <br />Monty ay Year <br />j1S. <br />Discrepancy,. .. p <br />lite. Discrepancy Indication Space ❑ Quantity ❑ <br />El ❑ <br />Residue Partial Rejection ❑Full Rejection <br />r <br />pI; 0 3 2010 <br />18b. Altemate Fadll y (or Generator) Manifest Reference Number. <br />� <br />U.S. EPA ID Number <br />F��1p'u�01�1D/'rENTAL <br />LL <br />FaciltysPhone' HL-:AJ_iH 3�E.'^'.r'TPr+"-�1T <br />w <br />iSc. Signature otNsemam Facany (w Generator) <br />Q <br />Moitih Day Year <br />v19. <br />Hatardous Waste Report Management Method Coda Cie., codes for ha�rdous waste beafinent, tlisposai, and r in <br />eryd gsystems) <br />2. 3. 4. <br />JfO . Designated Fad ry OmerwOpe ate Ce fication ofreceip ofha a dous ma edak overact b Neman fe ; exceptasndetlfottM teanniedrfyped <br />Name <br />Signature <br />Monty Day Year <br />;PA <br />Form 8700-22 (Rev. 3-05) Previous editions are obsdete. <br />_ ESIGNkTE:7 FS-:LtTafTC a?ESTINXiION fis','a' <br />