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f•---cam.-...""" "",+-soh-.tp.""'r—n..- w+-�a��"• ,...,,,�..•-"�.n,-�.�'".'-..,k <br /> k## a <br /> Pleas6 pnnt.or type v, ;` :'; `Fotm Approved:OMB No:205p 003 . <br /> UNIFOR,IN'HAZAR000S 1..Generetor IP:Ntmber :a 2.cage 1 of 3.Eme n Res onse Phone 4 ManifestTracMng Number <br /> WASTE MANIFEST rr Q Q .0 0 2 2 5 8 � �:. i i 800-B�4-�13� <br /> 0 7040,4 . JJK <br /> } 5 Y� �tiel9rx and Matting Address s <br /> Site <br /> g11Edress(if ddfeterd than mailing address) <br /> .._ 4 feI <br /> ` 10990 Roe Ave. ' 535 PascaderoAve <br /> R. Ovetiand Parte KS-:60W Tracy OA..93304 <br /> It t»�""ti erators Phooei 9 1 3 3 4.'4 5 2'Q - <br /> U.S.EPA ID Number <br /> e 'G7iNM€NTAL SERVICES': C: A D 0 5'3'8.'O 8 '7 9. 4' <br /> ( , <br /> Trans{iorhsr 2 Cw"W Name t U St.EPA1D NumherIPJV E ' <br /> x <br /> 8'l,,pp ��g� ami <br /> ..: <br /> U.S.EPA:IDNumber <br /> 4; <br /> 1030 W.17TH STREET' <br /> d 4 LONG eEAt H-CA`eQ813 OCT 0 4''2019 <br /> Faclfilys Phone,? 432-.5445 C A D t3 2 8 4 Q D 4 <br /> E ga '9b:U.S.:D&Descdpdoa(includng Proper Shipping Name,Hazard �e' n rs 11 Total 12:Uhft 13..Waste Codes <br /> 'HM- 'and Packing Group.(dany)) hIV V ���NT� <br /> o. . TYPe ::Quantlly. Wt/uoL <br /> foso s,2. <br /> O , <br /> wMRCRA Hazardous Iftste,Sotd(Ofiv DeOres) 181 <br /> P <br /> - <br /> '� s�O� <br /> 7 04 <br /> r <br /> 14 Special:Handling Instruction and'Addihonal In1brinahori a No. 0 O rudmut <br /> Always wear appropriate PPE whenNng<raste JOB# <br /> 15, GENERATOR S1OFFEROR 5 GERTIFICAMON ;I hefeoy declare that the contents of this consignment'ere'fd y and accurately described-above b&e prcpersfitppmg name and are c"ed,patiraged, <br /> marked Arid labeledlplacarded,'and are In.allrespeets in proper dondidon for transport according:td applicable intemafional and national govemmenta)fegulations:Ifexport shipment add fain itrg ft epr <br /> Expo Ite <br /> r,16e*,that the contents'of this gonsignment conform to'the.temis of the attached EPAAcknowledgment of Consent. <br /> wast minim nation statement identified.in 40 CFR 262 7/a if I am a la a uan enerator or 1 a:smail an' for is e' <br /> r. O( rg.9 �Y 9 ) N) Q MY <br /> G—Ms,P'n [Typed N Signattue MOO <br /> II Yeai <br /> • <br /> J'16.Intemational Shi is <br /> Irtpat to.U.S ❑Export from U:S. Port.d entry/exit <br /> r <br /> Transporter signature,(for exports only): Date leaving U.S.: <br /> 6� 17.TransporterAdmWedgment gf Receipt of Materials <br /> LLI <br /> 7rarrspotfer It yped Name Month Day Year <br /> i <br /> } ze Tran orter2PdAt6arry.p9d Name Sig Mohth Year <br /> {{ a <br /> i18.Discrepancy J. <br /> 18a Discrepancy indication Space t , <br /> ❑ Quantity O Type ❑Residue ❑Partial Rejection ❑Fu11 Rejection <br /> 1 8b AltWmat6 Facility(or Generator) I:.I pOSAL IRPATBSEIYr'OR REUSE CROSBY&0VERT0it1 eP�j tmbsrll{E PACDl1Y iJ1VbER <br /> tiRM[TS GRANTED 7'O Tf T.•/,BY THE DVARTMENT UFTO/r.SUBST! i CONYItOL,TOGFTHPz• <br /> U CFti I1E't]J11DtONMFMALI'ROTFCfION i GGFNCY IN AXCORDATrtT VfI7t THE.MOVISIOtiN U <br /> ua..FaCllity's Phone - "tER8S6l1RCE.CONSERVA77iJN AND:RECOxGCY:ACOF.1476 TOG_ESOIt.Wl'I71 1CRA: <br /> _ 'APDL. <br /> W 18c Signature of Altemate:Facility(or.Generator) <br /> - •'!:IU..�TS 7D ACCEVr THE REFERENCED:WASH A1DAt1 <br /> 49:Hazardous Waste Report ManagementMettt4d.Codes 0,e.,codes for hazardous waste treatment,disposal,and recyclIng systems) . M. <br /> 1 G 3. 4 <br /> 20.Designated'f Owner or for CertifieaGon�of . p(ofhazardc t s materials covered by the manifest except as n.ed to ljejn18a <br /> Pnntedff Sghature Month �r Year <br /> - - - <br /> EPAForm 8700• ev 1 A7} Previous edttloos are obsolete ' DESIGNATE=D FACILITY714 G NERATOR <br />