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Please print or type.Form designed(Dross as elite(t2yiltch) pewrfler. Form Approved.OMBNm.2050A039 <br /> x UNIFORM HAZARDOUS 1•Generakr ID N�mdwl 2.Pagetof 3.Emmgamy Response Phone 4.Man16Tracking Number <br /> WASTE MANIFEST CAL004310289 1 909-721-2038 0 0 5 049966 JJ K <br /> S.Gan l�' s� hngAddress GonareWs Site Address(if dllrnrent gran melling address) <br /> 4410 ROSEWOOD OR SAF'EWAY A 2707,6445 N PACIFIC AVE <br /> PLEASANTON,CA 94588 570CKTON,CA 95307 <br /> Generators Dhow 209-472-SSUO <br /> B.Tm der t Comya�t Noma U.S.EFA K)Number <br /> �VIRONMtNTAL LOGISTICS,INC CAR000172478 <br /> 7.Tmlm(sodon2 Company Name U.S.EPA D Number <br /> o.Ony�IgrCgQgq(gAqqaylCES, INC. U.S.EPA IO ut�mmbar <br /> 100 W.MONTE AVE GAU982444481 <br /> RIALTO,CA 92316 <br /> 8OD-898-4377 <br /> Fag ft Phone: <br /> ga 9h.U.S.OOTDesaiplion(mrLdng PmperShfpping Name,Hazard Class,IDNember, I0.CmnWF2 11.75181 12.Unit , <br /> HM and Pad'uu,IGmupffany)) No. Typo Clowlily WLA(ol. 13,Nasle Cortes <br /> ,. um y, J023 <br /> z 2. NQNKcRAHAzARurjuswAu1ELiQUIu4 <br /> W <br /> c9 <br /> 7. <br /> d. <br /> 79.Specid Hsndbk'rqg ksWcGaas andAddilircW InpgmaEo <br /> 9,Bi)/4BSORBENTWIFILTERSI:2n12D805 YJrS WEAR APPROPRIATE PPE INV#62907-N <br /> 98.2)WATER W/GAS4402122701 27") u <br /> 1& GEgERATOFrSIOFFEROKS CERTIFICATION:I hereby derclaaeml Na conimds at Nis caidgnmeni are fullyard uoraterydescAed aboae by Ne prapw slitaft name,and areda9sBed,packaged, <br /> mmkedand labeiardVeraded,and aurin at reepech N proper WORM farhempodemuMg U appfcable hAemagondand nagondgownew al ragdallons.0 eXpMah4maN and I em M Pdroary <br /> EVortos,l card lid Pre oornenlsof this corwignmaetconform In the Mrmsol the attached EFAAcknou4edgmerd of Conserv. <br /> I asfieygulgtewasle mhinhagan sletemmttWenWad In 4G DFR26227(e)(dt amalarye 4uaNitygenereto0 or@)(ifl eni a smog quanarygeneminl m hoe. <br /> Ganeratats(ORuMa PinslmYryped NameSignature �l�7D M h Day year <br /> 3 18.Intenregaal Sfdpmmkf <br /> E]raw la U.S. ❑ U.S. Ndofa We4l; <br /> 1— <br /> Transporter sltinaheo(forexpoM1sonly)c Dela leaving U.S: <br /> w t7.TrempalarAchmwledgmeMofReceiplofMelertais <br /> Transporter l PdnWTyped Name Si ono Day Year <br /> 1✓ <br /> Q TrampMer Name SbnaWreM1711IF Day Year <br /> ar <br /> r- <br /> 19,Discrepancy <br /> Is&Dkcrepanup lydlcafmn Space ❑ Waldty ❑Type ❑tiedee <br /> ❑Pantlalfleleogon EJ Art Ralacgan <br /> Mentleal Aekrence Number. <br /> 1Sb.Allemak Facility(wGaraalor) U.S.EPAIO Nember <br /> J <br /> U <br /> ran r"w,Pimm: <br /> 0o SlgndersofPRanak Facility(or Generator) Month Dry Year <br /> 4 <br /> z <br /> y19.Hrearrlws Ween Report Managamenl Method Codee(.a.,wdas forhuardova wade Weimer),dleposd,and reaping systsns) <br /> 4. <br /> 20.Designated Facility Orme) Operator,Cor6ftpyori afrocaiptofharardow meWlds covered by the merriest except asnded in Ross IBe <br /> l3dnWairlyped Name Slgsmlum Manlh Day Year <br /> 0? <br /> EPAForm0700-22(Rev.3-06 Pradomeditionsareobsolete. D HATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />