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111.. <br />Please Print or type. (Form desioned fres u.. M.m. <br />mar <br />sareob <br />1. Generator ID Number Form Approved. OMB No. 2050-0039 <br />UNIFORM HAZARDOUS 2. Page 1 of 3. Emergency Response Phone 4. ManifeafTmoking Number <br />WASTE MANIFEST C4R000186668 1 (30171368-477a 016162441 JJK <br />5. Ge Name Mailing <br />and Address Generator's Site Adtlress (rf tliRerent Nan maifing socress) <br />CON <br />CONSName nFUELS <br />F09 -C 5NEDEKERAVE 8D9 -C 5NEDEKER AVE <br />STOCKTON CA 9P2U3 STOCKTON <br />20946&4P23 CA 952-L <br />Generators Prone: <br />5. Transporkr 1 Company Name <br />ENVIR05ERY OCRRD001682U1 <br />7. Transposer 2 Company Name <br />U.S. EPA ID Number <br />P. Designated Feel Name antl Sfle Atltlress <br />DENENNO KERDOON U.S. EPA ID Number <br />2CAQO N. ALANED.A. ST <br />CONPTON CA 90M <br />Fast s Phone ($10)$37-7100 C .A T 0 8 0 01 3352 <br />9a, <br />9b. U.S. DOT Description (including Proper Shipping Name, Harard Class, ID Number. <br />10. Containers <br />HM <br />and Padorg Cm P (darty)) <br />11. Total <br />12. Una <br />73. Waste <br />Type <br />Ouanlity <br />1YtNd. <br />CodesNo. <br />Q <br />1 NON RCRA. HAZARDOUS WASTE, LIQUID (GLYCERIN, 50YBEAN OIL) <br />fl <br />343 <br />to <br />rte,. <br />i <br />3. <br />SV1�C?Dl1�ENTR(- <br />t <br />14 <br />j <br />-papal Hantllifg lnsWclions and Addri Information _ <br />9811374995-C-LYCEIiNlSOYBEhNO!UVL.;A.TER.MA. ERG*:951. 171 "ER5W.O.01294O5-ECP" <br />24 HF,ENERGENCY CONTACT: ENVIRO5E9V <br />?'. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedare that the contents of this wregnromm are fully and accurately desubad above by the proper shipping name, and are classified, packaged. <br />marked and Iabeletl/piaparded, and are in all respects in proper ocri for transport according to applicable intematemeland national governmental regulations. If export shipment antl I am Ne Primary <br />Exuortef. l candy that the Presents of this consignment conform 0 the terms of the attached EPA Acknowledgment of Consent <br />I pertly that the waste minimization statement identifietl in 40 CFR 262.27(x) (d I am a large quantity generator) or (b) (RI 8P a small quantity generator) is We. <br />GeneiatorYOReroes Pdntedrryped NameSignature Monntth, Day Year <br />IkIMCAC t V <br />N V I <br />_ <br />ti. Intemational Shipments <br />Import to U.S. ❑Expod from U.S. Ponofetmymoo <br />r anspcner signature (for exports only): Date leaving U,S.: <br />w <br />17. Trans Admowletlgmem of Receipt of Ytarmis <br />Tramp r1 rinted7fyped Na Signature Monty Day Year <br />Pr <br />) <br />I l <br />?raps 2 n ,; tame Signature Monty Day Year <br />j18. <br />Discrepancy <br />III <br />18a. Discrepancy❑ Indieston Space ❑ <br />Ouantiry, ❑Type ❑Residue ❑Partial Rejection Full Re'ecfion <br />1 <br />Reference Number <br />16b. Alternate Facility for Generator) US <br />U.S. EPA ID Number <br />J <br />V <br />LL <br />Ow <br />Fadlitys Phone <br />tile. <br />pnswm ofNamate Facility (or Generator) <br />t.1cr,!n <br />f <br />JzY Year <br />Z <br />W19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />0 <br />2. <br />3 <br />4. <br />1 <br />20. Dsalgnated Facility Chvnsror Operator: CertfKatron of receipt of hazardous materials covered by the manifest except as noted in Item 16a <br />rin Name Signature Month Day Year <br />FPA <br />Fmmn 11711(1.99 [R.. 11151 Previous edifion I t <br />soe e. .--hD i=t'CSCST ;r TC =� .".:5ATi4a a,">': <br />