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}icer <br /> r� <br /> Form Approved.OMB No.2050.0039 <br /> -%V& designed for use on elle(12•plch)""Ater,) R p n'utllacidii umber <br /> OUS 1,Grrerabr ID Number 1.Pape t of 3.Emergency espon <br /> EST c A'L o 0 0 2 7 8 8 s 9 1 soo 424-M 0-1 010189486 J JK <br /> Gerrerata's Site Address(H deferent fm mating aria=) <br /> ' PROFLEET INC. <br /> EET INC LODV 15619 N THORNTON ROAD <br /> 9QR4N2TON'ROAlY' LODI CA 95242 • <br /> CA r photw, 9.1 6 . 8,3;4 9 5 3 4 . us.EPA m Number <br /> 4. � ^�� C A R 0 0 0 1 71 0. 1 7 <br /> I=& UW ENVIRONMENTAL SERVICES INC <br /> U.S.EPA m Number <br /> T.Tgnspouet;2 Canpenp Name <br /> r U.S.EPA lD Number <br /> T, C:tiO C,ORDOVA.LLC the PSC ENV.6 <br /> Wr <br /> 148561E1 ITEA00K ROADir., <br /> RANCHO CORDOVA-CA 95742 . G A.D 9 8 0 8 8 4 1 8 3 <br /> > Rbciw:: 916 351-0980 <br /> ga, Sb.U.S.DOT Desaip0on(ndud ng Proper SN Name.Hazard pass,ID Number, 10.Contaners 11.Total 12.UnA 13,Waste Godes <br /> v HM and Pscl&VGroup Many)) No. C1uar:tiy <br /> Type YANoI. <br /> its' a 1.NON=RCRA HAZARDOUS WASTE,SOLID(OILY DEBRIS.- �3 <br /> ABSORBENT) <br /> q F- Z .D M 6ao fi <br /> - <br /> Z.4. <br /> my <br /> ' t 1.)3 $:168 �0A DeWSlERG#17 <br /> EAI UM&To aE:ik RTRAWW ADII3.UMPM <br /> I& GENnwoR'SIOFFEROR'S CERTIFICATION:I hereby dedare gut ere contents of this cow*mere ere 1Wy and amtrately desabed above by bre pow shiw rrame-and are dass�m,Pam• <br /> ,,rWd end labeled placarded,2nd are h at respects in proper co wbo,for transport a=ding to apW4cebte bvematiortai and national governmental reloatiom.tf e)port 4Kpjwt end I am the Primary <br /> Furter,I certify ttw one contents of this mw9riment ardor bus teens of the aeadted MAdorowledrtent of ConsenL <br /> I arb Mat the waste minlmtzafion statement identified in e0 CFR 262.27(2)(d I an a large quan*9etwabr)or(b)Of I em a quantity generabr)n'_ No= Lqty Year <br /> Is Prnted/Typed Narrte ' 3 ZZ i3 <br /> kr <br /> MblwnNdnwSt*rwft from U:S. Port of <br /> ��ro�rt'b U.s. <br /> �yg�lefsigmttue{trr_e�ortettti/) Date U.S:. <br /> W. 17.Tttnaporw.. rrafR!cNp!dMaterials <br /> Mta1 POs'. Year <br /> Pt +�.•-7� -- f3 <br /> ;7�. TecstpoQer. P . yW Signa Monti r,.� Year <br /> DircrepanYdodlceow Spas L omily ❑ ❑Residue perw Ra)z <br /> MartfsA ReNimoa Number <br /> y F b(•Caatinior)` U.S.EPA ID Number ; <br /> +CG<lq' MontU uc ' . Year <br /> la. Fa�lya PMne: <br /> Y 19.Hiardout MMIe NVO"Wt AWtod Codec(U.,oodesbr haordnn waletreatment da00ad and re g s1 ) <br /> it <br /> Calf limlon of recoO of haardous rrrolerists wood by the tnen)fesl two$as noted a► k <br /> 20.Daebn� y 0aerrortlparalot, e ` ; Yew <br /> v <br /> AFamarD�?3:(�+• p tsare obsalatP- DESIgNATED•FA I..' TO DESTINATION STO (IF REQUIRED) <br />