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NOV. -29' 95(WED) 16:55 CITY OF TRACY TEL:209 831 4430 P, 002 <br /> .Slcla of Califarnla-iarlth and Walram Apenty ~111 r�__, �f <br /> FCUP-No.7n AD13roved OMy.2135D--nD39(Expires 1,30.91) 0epartm6n1 ar Haan$prvioes <br /> t+iaeae prir5t pr lypa. fFdnn dsaiptred/ar lise on apes(12pitch IypewrQ tom•` Toxic Sub'1enera Cunlrol Division <br /> UNIFORM HAMR , eneram'.US EPA In NQ, snaramaampailornia <br /> ��V� iGtMarriha! 2- Pa9a Informallva in The shaded 1 aralva <br /> 1NAST� MAI�IFE$T Daalvnera No, <br /> le aef required by Fadare4 low. <br /> s- asrataCla Nrerp d Meill1tlp Address <br /> �'I!`'L + 11 �'Z7f�h R r}f I' /3 A_ Stals Mand 8 4aewtyal I0 77018-5- <br /> 4- •r1 r 1» C F-'.1 •��f B.91eta 0�narernre AD <br /> t a- Goneratctr•a Phone('�' , ] rr <br /> S. Tr sv rter Comb v 4 <br /> rD j G. UD Number S EPA I <br /> J/ f i I C, Sta a Tranapuriere ID <br /> —r; <br /> t r),� F r r D_Teaa4ports s PheAe ' _ <br /> 7. 94 <br /> renrponer 3 Company Name A ulvr a i r <br /> o _ 6. Slate Taanaponvra 1p <br /> to F,Trartepartwe*Phone <br /> B, De:ipnatud Faeildy Name end Site Addreen <br /> t4. US EPA ID Nttnber <br /> r j G.Style Facilitya in <br /> Ali£_ r:i e <br /> vli -- N lve <br /> Fu fi.US DOT Deaoiplloe(Ncludhig Proper Shipping Nanfa6 He—d Clava,and Ip NumbaQ �2, Cgntainery i5y.TcNal <br /> PP Ouaailty ijnil Wavle No. <br /> •U a + `J f J Na- Type Wilval <br /> z C i��fff. ;.r {='t f �.a :l 1 / Stage <br /> E <br /> N <br /> E b <br /> R <br /> A Sts1e <br /> � 7 <br /> O EPArfhhar <br /> 4 R C. <br /> a Slate <br /> m <br /> � EPA101her <br /> w d. <br /> WSlate <br /> V <br /> w EPAJOlhaf <br /> J.Additional DeavlFlier*ter Matertvle Listed Aber. <br /> K. Haadllap a ae tar Wwoz Waited Above <br /> V7 � a• b. <br /> ES <br /> t <br /> R <br /> t 5.Swia!Handlied Insteut7i'00e Blvd Addfiorral Inlbrmation <br /> d <br /> J <br /> j 18. <br /> eadOtvItTDA'S CEPacke ,ntafk 1 hereby lectan that thv cantanla at Ih]s celveignmeat are fully and aacvmety deaeftbad above by proper*Wppin¢name <br /> end cry cleaallle4 packed,mertad.and labeled,and are In all reapecta In proper rmadte on for Imneperl by hiabway mvverding to appllaeala internatltlnal and <br /> A nnf anal poremrnentreGelaliona,. <br /> r u era u large aulvntky gaevrnlar.I tNtf that I nava a ro ram Ilv leen to reduce rho volume end loKlclty al weals peneraeed fa the de <br /> l,ba ecpepmlcalty preelicable,and]hot I have aataclod Me pratti able method Of treatment,storage,or diepaeal 0 11""'Kly avdIs the tQ ma Y 1"Ava <br /> rnia mrx i mb <br /> present me trddn threat b human ID ME and the envy od the**t1R,lv I em a amau a[alvrniry excavator,t nava rrnrde a aooa faith efrort ry miaimixa my wame <br /> j peaaralign and saletr st+a beat weStp:manaptxnxnt metfrod the*is available,to me and that I can alfnrd_ <br /> u Primed I`Type Mame 91Qnature <br /> IJ <br /> !f Monrh [lay Year <br /> r r, . <br /> �. <br /> i T t T. ranapermr t Acknarrtady and e!Rec4ipt 41 Mele6d# ' Y <br /> A PrintxdfTyved Name Y <br /> ] if Signature <br /> rt r {' ldontn Dy fou <br /> Pj r 1 <br /> a O to + ripener 3 Avkpd,&1g;eliJVrd&0 at Recaipr of Ustadale �- r <br /> k R <br /> E $idPrintee/TypedName •. <br /> j natur�e Manth Dey Year <br /> R <br /> 19_ DiaarepancyIndication Spepe <br /> A <br /> C <br /> I <br /> L <br /> T xo. Faeiray QWIW d operator Cartilicatlon of receipt Qt hazardous maferiele'fared by rhia mwles <br /> t wwopl ar noted in Itam 19, <br /> y Prim a r I Vped rdsmp �. SI <br /> �Y'i Month Dav Year <br /> is 602-1A DIM <br /> A D NIWrite law <br /> e7o�zz M This Line <br /> rv.9-M Previnee edllitlne are obsolete. <br /> GREEN= HAULER RETAINS <br />