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0 Su,/t) <br />Plrmm rxint nr terra_ iFnrm daub ned for uaa bn wife (12-oitchl lvoewrilar l <br />Form ADWaved. OMB No. 2050 -MU <br />EPA Form efff'(Rk 3-05) ftvltwa 60lom are obwlete, t TRANSPORTER'S COPY <br />UNIFORM HAZARDOUS <br />1. Generabr ID Number �t}L. # ".+� ; <br />2, Page 1 of. <br />Emergency Respoume Pham <br />{{^�� Naarnber <br />}. <br />3ll.� 2 e 6 FLE <br />WASTE MANIFEST <br />5. ACME TRUCK PART* tmnmaengaaldrse) <br />1016 S. WILSON WAY Ar'i'd WAYNO GRAI <br />STOCKTON, CA "206 <br />Gds Pham: <br />B. m ams U.S. EPA 10 Number <br />INDUSTMAL. WASTE UTUZATtON INC.CADW056.620 <br />7. rar"orfer 2 Cwpaq Name U.S. EPA ID Number <br />and sre Addrew U.S. EPA ID Number <br />AA 'Vllic 1, �. 4 <br />40,26 e.' JFACtOR ANFF <br />` ? AF: "36.5 <br />F A . <br />ga <br />9b; US. DOT Desalptlon (induding Proper Stwppkg Naarb, Hazard Cleea, ID Number, <br />10. Ca>fanars <br />11. TOW <br />12 Unit <br />13. Write Cordes <br />No. <br />Type <br />HM . <br />a4 Packkv QVV (t any)) <br />OuenUtll <br />"Ati. <br />t. f$po RAMA "ww—Ociw Vlrasto bolid <br />3 2 <br />�illlar'�'Cllilw} <br />2. <br />3. <br />4. <br />114. SpKWNmeaudlons wwnadm <br />913 - <br />15. GENERATORWOFFEROR'S CERTIFICATION: I hereby delve tmf tm oottlarde of tltt cormiprwtmrt are tiny and aaxuatey rfescxibed above byft proper aNpPMrG name, and are dessilled• padaged, <br />marked erd WAdlptecarded, end aro In ab reepaclt b proper owdAfon for trer"M aarordkrg to applicable lnlemadoW and its b governmental repWdom.. N expel ehvwl and I am the Primary <br />Exposer, I oe * that tm coolerds of fhb mnsignmad conform b dm femN of tm madmd EPAAcknowledgmerd of Conant <br />I aerdiy Nmt tm wait r 0ftizatbn staMmant WOW In 40 CFR 282.27(s) (t 1 sm a kegs quwft generator) or (b) (d I am a small cpmlty generator) is true. <br />Rk*ffyped Non Month y ev <br />is <br />1� ❑ Ispat b U.S ❑ EVW kin—U'.& Pat otvrtr*At <br />2nj2Lw signan up" orgy): Date leaft U.s: <br />11. Ttarmpo wAdatnefs#nw of Receipt of Malerials <br />12, lJrJJl <br />MUM', ... mom "Uffy f Taw <br />18. Discrep>mcy <br />18e. Dbaepuwy kulcatlon Space ❑ ddb, ❑ Type ❑ Residue ❑ Partial Re ,d. ❑ FuN Re cdm <br />Mv&g Rafer rbe Number. <br />18b, Ahmale FecRty (or Generslo U.S. EPA ID Number <br />J_ <br />v <br />F e Pham: <br />18c. SiwAse otMemals or Garmrebr) Morm Day Yew <br />6 <br />Z <br />ig. Hazardous Waste Repat Marsger mnl Mood Codes (i.e., codas for hazardous wade besitma N, diep". and racy ft systems) <br />1. <br />2. 71- <br />4. <br />20. Desoigedl Fwft Dw mr or Operabr: Cerfiketian of rlecefpt of Mzardous materiels covered by to manbsl except as NW in 4A 1pe <br />,!; New <br />EPA Form efff'(Rk 3-05) ftvltwa 60lom are obwlete, t TRANSPORTER'S COPY <br />