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SSL SK SH I PM 218089921 l I I II I II I I I I II I I I 11111 i I I I I <br /> 0 0! 2 4 4 9 2 2 5 K 5 <br /> Please pent or type.(Fcnn desl ned for use on elle(12-pita)typewriter,) Furn Approved.OMB No.2050.0039 <br /> UNIFORM IWARDOUS I I Generat"r ID Nino°` CAT000613968 1 2 1-11°r _1 F W4W , 2 Manlitsl Trackl Nwnber (+��(( <br /> WASTEMANIFE•S+TT 0052 •4922 SS <br /> fftV V' "?rEMS, INC. ' Ftly �� I�t S�51INC. <br /> PO BOX 555 5@50 SALIDA BLVD <br /> SALIDA CA 95368 <br /> Genera;-Prose. 209-545-1011 SALIDA CA 95368 <br /> 613MPT -OWEE1VeSYSTEMS, INC. US.EPA ID Number TYRO00081205 <br /> 7 Transponer 2 Company Name U.S,EPA ID NurMer <br /> 8 Desgatad Faality Name and See A cnr — , INC. U.S EPA 10 Number <br /> 6880 SMITH AVE. <br /> Ci) '��+,-,r;0 <br /> 510-795-4400 NEWARK CAD980887418 <br /> Fadkys Phone* <br /> �j ya 5n U S DOT Dasalpeon Indudln9 Props*Shppm9 Name.INTard Cb..D N..bw. - t.��; 12.UM 13 Nfab Cod.NM me P.rwgl C—P(A any)) ,a�.., wuvd. <br /> cc o (USED WASTE,OIL) _ <br /> z 2 <br /> w <br /> C7 <br /> 3 <br /> A <br /> to Speaal hrohng hstruaiors and AcI tonal Irfvrnelwn 77 <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) <br /> AUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION:1 hereby declare that the somans ons mnsgnmeM are MN and aawalely de abrn by me proper shPpm9 name.am we da"66d.padaged. <br /> marked aM laneledokarded and ere v1 all respects ir pincer c ;bon"hansom aF dng In <br /> ep(acabk�tenkroaletw gae^menkl r6gu'as«n M eom srhpnkm aM am me Pnman <br /> Erponer.I ceroy that the comms rima m sgnrrr t rn form*the Terms d me anw1w EPA Ackr voedgmem of Content <br /> I;er-dy Nal"%2616 mm—al-slat—t denhfied'n 40 CFR 26227;a)(of I am aIange duanoy gen ev)a@I lett am Ruanby 9eneram1r 11"1 <br /> Gakra s'Oderoes PnntedTyped Name Sgalum Mimes/ Daily veer <br /> to Slupaens ❑1`�­to U S ❑Egan nom u 5d <br /> TrintpprW agaGae lhr azPons onN� k leil U.S.: <br /> Cr 17 TrarygorlerAdnb+sMdpmamdRetelpldMakrkl5 f <br /> T-an 1 PmtedTyyed Name Sy k!ue Moan Cay veal <br /> 0 G b <br /> Q Imnsponin2 Prole0yped Nam Sgrrawre Mmm Day year <br /> I <br /> 18a Numpancy htdw ecn SD2oe [IOuanWy ❑type ❑Revo.:r ❑Part�Rexscn ❑Ful Rol r <br /> Manifest Relerena N,mbar ; <br /> P 18b.A4anhge Facially(w General«I U.S.EPAIDNurr'ba <br /> 7 <br /> U <br /> I'whys Prom. <br /> W1ek.$y,a'aaa o`AAenwla Fauhy la 3enFatvl Mean Year <br /> y1 S Hazardws'1Waste Repro Mana;&W I Muted Cadet 68,codes fa hrrdaus-w treatment d6posa:,aM recycling systems) <br /> LL, t Cl�� 2 3. a <br /> 2C.Deagaled F-Py 0.—n Operator Cenfiaeon of wto or haurdpu m WmN covered by the manlest a as:wed m Marn tea <br /> Pr yp�d Name _w Aldeh eV <br /> EP6FgrgR*7 F,(Bev3b51 Prevous edit*ns are obsolete, Dc�IGNATF.FACILITY TO DESTINAT N STATE(IFA UIRED) <br />