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Mease print or typo.(Form designe0lor use..on Me(i2•pildh}.typewrilef.) __ Form ApproJeif,DM8'No.2050-0G39 <br /> 1,.Generaidt t0 f1'u be! rg ^y ponse Phone 4.k0184'86093 <br /> a}rifest Tracking muster <br /> UNIi•OftM HAZARDOUS !n. 2.Page.f of 3.[me en_ Res <br /> WASTE IAANIF.EST C A. C 0 0 2 9+13 r e B 0� 1I 800.$24-813@, U 1 Q /) 0 6 0 9 3 J J K <br /> 5: n0 IofsN <br /> and Mail drgs's Geileralors'S!teAddress(it ddlerentthan mailing.address) "s V U.J <br /> ��aa�cton�'ountry�uA�i <br /> -1800 wen.CoUhtry Club Blvd <br /> Stockton CA.95204 <br /> Generators Phone: 2 0 8 4 5 6 - 4 1 .3 _� <br /> 3.TranspoAer 1 Comppny Name ,�� U.S.EPA 10 Number <br /> Patriot I~nytraritrtental Ser�ric�s __LCS A D 4 5 3 S 0' tj 7 sa <br /> 7.Transpprter 2 Company'Name '- — US,EPAfl Namber <br /> 8.AaubatctCFac.tiy�fittpk.�d„S,t,..Address U:S:ePAt6 Num6ar <br /> 1161 Gf MST i 7TH SHEET <br /> LONG.BE.ACH CA 80813 <br /> Fade s Phane:.800 827-6729 1C A D 0. 2 8 4 0 9 0 �. <br /> ga a U.5:DOT Destrlprim(Inclufrg Rwv Shrppmg Name,Harsrd Class,0 Numter, loXontainers. 11.Total 12,Unit <br /> HM and Pacing Group:(f any)) 13.Waste Codes. <br /> No. I Typo duan* "Aio. <br /> oNon-RCra Hazardous Waste,liquid(Aqueous Saltniott Wrtfl tdetals{ 132 ) <br /> Restricted Lev Ols) <br /> �. <br /> G.'01 2 QF 00i00 G ; <br /> LU }on-RCRASolid Vt ste.Solid.(Solid Debri 7 <br /> c� <br /> 0 0 2 DM 00200 r <br /> P <br /> I <br /> 19.SpecWHandl;ngIns''tudons and Add(lianatlrbrmailo.n 1)Job f1i-iM02932),. <br /> Alwws wear appropriate.PPE when handling waste,.J084 <br /> 15. GENERATOR'S!OFFEROR'SCEitTIFICATION:lhenbydeclaro'that_,hoeoialanlsof(hisoonsgrurentale'tullyauJactralolydoscnbeda4o'vcbythe,prop�tsrippingnamo,aaa�cta9slr�d,paskayed, <br /> marked and laheledlpla=ded,and are Gia➢rospocis in proper corrdiUCO,for transport 2coor3ng M appficat'o irloma@artil andnational goi emmentat rCgu!at ons;If expads!hlpinent and r arttthe Pr ma y <br /> Exporter,I certify that'lho wntents of this conslgnmentcooform to the tams or1he stla&md EPAAeynarMadgrrentof Consona: <br /> I iartify that the ymste minim@orlon 36terngnt(dent Sed in 43 CF9 2322(a)(rf f am a largo quantity gewmior)or(3)(f tam a,mall quanldy generator)Is hue. <br /> GeneraloesloffarcesNnl M.ped Name- Snuro r MIln py Yaat <br /> :c'i —_" _ Z-"" <br /> .j 15.International Shpmcnts i <br /> ❑Import toU,S. �.�EspnitfrcmU.S. <br /> Transporter sb.ja(ure(for.experts only): T Data leaving U,S.: <br /> � 57..Transporter.Ackndvled0;nentoiRece:ptofMa'etiais <br /> OTransporiot I Printed/Typed Name nature.- <br /> , 5 t / '9 _ Month D/ay Year. <br /> CL <br /> 4 Ttansportar2 Printed/Typed Name <br /> S gnalu o Month Day Year <br /> N <br /> M-Discrepancy. <br /> 181.�fsuepancy.tndcahon.Space r � <br /> LJ Obanlity. T -, � �i.= ^ LJ Residue t!PerflalRejcu'nn ❑FuhRe`,•�-��z� hon <br /> �� -�`�'�Man'i-fe-s-t-Reference Number: <br /> 18b:AlterimleFzdlity for Generator) JHIV V J— LUIJ U.S,.EPAIDNember <br /> U <br /> u Facility's Phoma: <br /> w' 1(3c.SgnatureofAllentale FwAty(orGenerator) d ntar - htaslh Day Ytar <br /> V19,Hazardous Wase Roput ManagementtMeftwd Codes f.e„codes for hazardous waste trealmenf,&posal,and recycling systa_) <br /> q 1• 2. 3. 4 <br /> 20.Designated Farsity thmer.ar raloi:Ce lificxtcn of recetPI of hatadow maL-rials covercc by the man)fesl except es naedla Item 181 <br /> Pinta yped Name - SignaWre: I&Mth Day Yaar <br /> 44 _ _I --- _ <br /> EPA Form 8700 ay.3-05) Previous edili�n. are obsole{a; tis 1G1�'.',PFJ E` (:It) .( _)F l t1a,71f}N STATE(1F N(=(':'.J}i EBS <br />