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Please print oc type.(Form designed for use on elRe(12-pitch)typewriter.) —T4­ <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.G°"°raWr ID Number 2.Page 1 of 3.Emergency Response Prone < Man let TrecMng Iallbef <br /> WASTE MANIFEST roa (,' r} 1-- � '' f -`, r197 000091046 DAT <br /> 5 Geneatoes Name and Massg Address Gahrabys NO Address(ddNBemnt than mailing address) <br /> Tesoro USA <br /> ISO Solana Way 25W W Lode Av ,.L-a <br /> F'eclmco.CA 94553 Lad,CA 95242 <br /> Genereter's Plhr�42S228.1220 u.s.EPAIo rAmber <br /> 8.Traneporler 1 Company Name <br /> FmIrt71m1aMa9 RelnsNes,frit ClV.(JOU371038 <br /> 7 7renspoder 2 Company Name U.S EPA ID Number <br /> UNI Waste CALLVD31732tY <br /> I Designated Fac ity Name and SdeMNess AU.S EPAID Number <br /> AxunoN I.eI1tldY CAL1081382732 <br /> 10840 Atrmant Pass Rd <br /> LNemtore.CA 94550 <br /> F 2L, sPhone925 155-7.100 <br /> 9, 9b.U.S.DOT DesaitaOon(including Proper Shppig Nano,Hazard Class.m Number, 10.2on1ere11.Total 12.Una 13.Wass Codes <br /> HM and Paddl9GlwP(dany)) No Typo OuaM6y WUVol. <br /> R 1. R.Q. NA2212,ASBESTOS,9,PG III BA 'Y 151 <br /> 0 <br /> z z <br /> w <br /> co <br /> 4 <br /> s. <br /> 14. sandAdWti Iln=wbw <br /> FRIABLE ASBESTOS CONTAfi'494Ci WASTE/BMAMD 939 ELLIS ST,SAN FRANCISCO,CA 94109/TRIMLSPORTER 1-ER13910 YALLq <br /> AMEN IE,PLEASANTON,CA 94588,925-481-32W I TRANSPORTER 2-M WASTE 17100 LAMBERT RD.,IONE.CA 95840 4 <br /> or <br /> 14.1484 It a <br /> 15. GENERATORBWFFEROR'SCERTIFICATION: I hereby declare thatch contents of this mrugrmad are telly and sommalydescribed above by the paper slapping new andare dassl8ed•Packaged• <br /> marked and bbeledoacarded,and main all respects b proper condition for transport according to applicable intemebocaland national governments]regulabnns.Nexport shipment and I am the Pmiay <br /> Exporter.I certify that the contents of the crosgmenl conform to the tern d dh adached EPAAcknDMedgment of Consent. <br /> I teddy fel the waste rax m sesso statement renldied n 40 CFR 262.27(a)(if I arrl a large quantity generator)or(b)(gl am a small qua pay geraI as boa <br /> Gacrasf�G%D's Pnn edffyped Name nature/.- ,m c/'' (r,,l.. _ Month Day Year <br /> J16 Intenaem Onants ❑ImpmbU.S. ❑Expel Imm U.S. Pad oferAy"t <br /> Transporter sgname(for upas only)_ Das leavag US- <br /> W 17.TaisspoderAcknoWedgawd of Receipt of Mannas <br /> rernpoder 1 PmtWgyped Nam Sgnaoae 1fea <br /> a1;, <br /> l� Li/rarssporter 2. d yPW me Signature / Noncar Day Year <br /> i18.D amoarKy <br /> 18a.auapawy IndcaGon Spam El Quabty, [:]Type ❑Resaa e ElParw Reiss m ❑Ful Rejection <br /> Manifest Rasanro Number <br /> 18b mmuo Facaty(or Geremw U.S.EPA D Number <br /> J <br /> U <br /> sari Fatlilys Prone <br /> .Signature alAllenale Faclly(or Geneabq Month Day Year <br /> 4 <br /> 2 <br /> S2 19.Hazardous Wass Report Management Nabbed Codes(i a.codes for hazantous wales beaanent disposal,and recycling systems) <br /> D 1 2 2 3 4. <br /> 20 Designated Faality Owner or Operator.Cerafiraam of receipt of hmrdous materials covered by the modest except as nded b Item laa <br /> yped Namej� gnasre y Year <br /> Y k-'+ r'( jlT <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY'S COPY <br />