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02/08/2007 10:01 FAX <br />• <br />pi.—.,gar ,rr wra fFnmr cheesed for um on i like f12 -clad) haewriler.l <br />a 002/002 <br />Form Approved. OMS Na. 2050-0039 <br />, <br />...... UNIFORM HAZARDOUS e t C"aer2M ID Number <br />2. Paye 1 of <br />3. Emegerlcy RGW Ma Pnene <br />4, M� O �g Number O JJ K <br />WASTE M.INIFEBTrry) <br />- <br />c <br />5. Liam a li Name and bidding Audrms Genera ors Site (KdMerent Man mailing address) <br />ju <br />Ultra Mar Lnc. <br />685 tar. 3rd Street 470 N. Main Street <br />�,4 tine; c 932301559) 583-3298 Manteca, ca 953 36-3SU <br />8. Trenap�Nf 1 Fla 111a Name U.S. EPA ID Number <br />Oil Conservation ,Service, Inc- CA'D 980 673 E142 <br />7. TrampodS.ar 2 Company Name UEPA ID Number <br />S. Designated Fadi tyName and See Address US. EPA ID Number <br />Riverbank Oil Transfer, LLC <br />5300 Claus Road <br />Qiiyix3aank, Ca 95367 1209;863-8181 Ci',L 000 190 ;316 <br />ga. <br />9b. U.S. DOT Destllpden (Including Proper Shipping Nemo. Hazard Claes, 9) Number, <br />c4mialners <br />11. Total <br />12. unit <br />13. Weele Cadge <br />N. <br />Type <br />HM <br />and Pa14ng Qro4 Et coy)) <br />Oumfity <br />WLNd. <br />cc <br />1. <br />NON RCRA HAZARDOUS WASTE. t.JQUID <br />CC]. <br />'PS <br />G <br />2lJ <br />o{d <br />used DiJ-/mixed e1,1; <br />025 <br />i <br />2. <br />9 <br />4. <br />i <br />4, pedal Handling Ins9u ae and Additional information <br />ERG# 171 invoice 4 30090, . <br />1ti. OENERATON'51OFFEROR'S CERTIRWON: I hereby diadem Mettle Wnlerrm of this onsignmem are fully and edcumtey described above by the proper snipping name, and aro designed, petalled, <br />marked and labs a llpl6®med, and are In ell reepetls In proper condition for h imig0l according to applicable rmma9prel and Maud gm*mmenotl regulation, K export shipment and I am the Primary <br />Exporter, I earth, that the mnleas m this can ignmem mnbrm to tib term$ of the enacted EPAAdrnowle0gmml of Consent, <br />I caddy met Me mate mlmmNttbn statement Identified in 40 CFR 7E221(a) (91 am a large quantity ganeralor) or (b) (91 am a small quantity gereretor)'s Vu6. <br />Cmxabt's O9e e''S PlimeNyyped Name SONWrg/J /� �-' morim Dar r <br />i C/ <br />CGr�!ici '1/ l <br />19.Imematmal shipments <br />❑Ito M1bU.S. LJ Erpellrpn U.S. POM1 of erNy/B <br />Tlanworter sigNmm(for eeporar any). Debi lea S•, <br />17. hanepoderAranaM,adgment mHemipt of YAWNIS <br />µK <br />Tmmponer 1 Prmed/l)rped Name SgNau , / Month Day Tut <br />7 4 <br />Tmm 62Pd ame Month Dry Year <br />19, Dlapapamy <br />Ida. Discrepancy lnousam fip6te E]Quantity ❑Type ❑Reddue El Paul Rsfectlan Full Rofactlon I <br />Manifest Reference Number. <br />19h. A9emate Why (a Sam rai" US. EPA ID Number <br />W <br />Facility's Phone: <br />W <br />18[. Signorine 0ternale FedIM lot Generator) <br />Miami, Day Year <br />co <br />19, Hazardous Were Report MBnegement Method Codes (14., codes lorhaiedous weee neananl, disposal ata recycling systema) <br />r�a <br />2. 9, A. <br />29. Designated Fadlly, O werorOperolOY. CerdfraVan of mceipt d hprardms melaia5 cove" the man9ast except as now In Item tae <br />nkdRyped Nems ,: �, 9 Signature % Worth Day Yur <br />EPA Form 8700-22 (Rev. 3-05) Previous edition am Obsolete. - DESIGNATED FACILITY TO GENERATOR <br />