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0 <br /> Please print or type.(Forth designed for use on elite(12-pltcJrr"swmerJ <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Genealor ID Number 2.Page 1 a1 3.Emegsncy Response Phone 1.Merdfest7ackl� umber DAT <br /> WASTE MANIFEST 3 7 00009, 1046 <br /> 5.Gemtrdors Name am seen Address Geneasurs 5neAddress is carmen bran malting address) <br /> Tesoro USA <br /> 150 Solaiw Way 2500 W Lodi Avenue <br /> Pacheco,CA 84383 Loco,CA 95242 <br /> Generators PhaA25.2Z8-1220 U.S.L-PAIDNumber <br /> 6 Transporter i CompanY Nanta ECAL000371038 <br /> nvlyonmerial Remedies,Inc <br /> 7.Transporler 2 Company Name U.S.EPA ID Number <br /> UNI Waste CAL.OIX317320 <br /> e.Designated Facaity Name and Site Achim <br /> �Ieftrsca� � U.S.EPAID Nrmes <br /> CRD081382732 <br /> 10840 A4rma11 Pres Rd. <br /> L.Ivelmae,CA 94550 <br /> Facldtya wwnea25-155-7300 <br /> gra, 91b.U.S.DOT Description('including Proper Shippxg Nanta Hazard Class,ID Number, 10.Containers 11.104111 12.Und 13.Waste Codes <br /> HM and Padang Group(danyl) No. Type Quantity WtAw. <br /> X T R.Q. NA2212,ASBESTOS,9,PG III BAY 151 <br /> o Z- <br /> z 2. <br /> w <br /> t.7 <br /> 3. <br /> 4, <br /> 14.Spaau Handling l a ton <br /> FRIABLE ASBESTOS CONTAINING WASTE/BAAOMD 939 ELLIS ST,SAN FRANCISCO,CA 041OWrRANSPORTER 1-ER13910 VALLEY I <br /> AVENUE,PLEASANTON,CA94560,925.481-3285!TRANSPORTER ZUNI WASTE 17100 LAMBERTRD.,IONS,CA 95840 <br /> 14.1484 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare out the contents of this ounsignmem are fully and accurately described above by Ne poper shipping name,and are classified,packaged, <br /> marked and Iaba"placarded.and are in an respects in proper condNon for banspal accomirg to applicable international and national governmental regulations.If export swpment and I am the Rimar, <br /> Exporter,I=*Nal Ne contends of this consignment conform to the terms of Ne attached EPAAdmoWodgmanl of Consent. <br /> I certify dal the vasal mamzation solement demiAed in 40 CFR 252.27(a)(d l am a Inge quantity generator)or(b)(AI w a erred Wtay generator)is trio. <br /> Gereatar�1lOdemrs Pnn ocRYped NamaS / J1 yCP C4 Monty Day Year <br /> F 16 intemati Shipmate El law W U.S. ❑Eipw born U.S. Podofentryladt <br /> M Transporter sgnalua(for exports orly). Date arwing U.S., <br /> of 17.TanspoderAcIrnowledgmam of ReceiplOfMaterels <br /> anaporter 1 Prim VTyped Name Sig Month Day Year <br /> OzU /i - l 16 14 <br /> Sa. Transp---' i yped Signature Month Dry Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indcalwn Space ❑ Ouanely, ❑Type ❑Resdus ❑Partial Re)e ocrn ❑Fug Rejection <br /> Minutest Reference Number <br /> 16b.Allemate Facility(or Generator) US EPA ID Number <br /> J <br /> U <br /> LL Facildys Phone. <br /> w Sc.SgnaWm of Alternate Facl(or Generator) Monty Day Year <br /> 19.Hazardous Waste Report Management Method Codes(ie,mdesfa hazardous waste treahnent dopesal,aM recycYng systems) <br /> 3. 4 <br /> 20.Designated Faddy Owner w Opealor Cenifivation of mcapt of hazardous mussels covered by the manifest except as noted in nem 16a <br /> PdnWypedam r-71-; ; dna" Month Day year <br /> EPA Form 8700-22iRev.3-05 viouseddions am obsolete. DESMATED FACILITY TO GENERATOR STATE(IF REQUIRED) <br />