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11/25/2015 WBD 11:21 FAX 2098704468 ServiCeAdminMFD _ _ 11/ 014 <br />71 <br />FolmAp roved. OM9No, 2050.0039 <br />P4eals pj.�rr Form designed IN use m alhe (1Y Ptich) wdler' 2, Pegs I 3, Emage KY Response m 4. Man Treonq urn or <br />OU<F�tRM HAZE RDDUB Gane aior 10 Nurnbp 013804698 <br />h ASTEMANIfEST ioa) �i�U� <br />paneraton 51a Andress d'drert then mallhq address) <br />onaotofs Name and Friel g Address <br />BIG VALLEY FORA UNCOLN 2$2q AujO CENTER QRC;LE CA <br />T�A�Ck1'4h�19G39 CA0 ' STC?GtfTRN <br />��7�.i — r« S. FPA DNumber <br />r rtfhone. <br />cn u 7 9 <br />:..d�.,'iTrjlllBpORer'I C9mParp Ytlt�y ¢ 4 2 4 1 Z i. . <br />7rr. rtnspodor 2 Company ems <br />9;;Desgndad Faaluy Nome an nas <br />Egow WA 11 noHU <br />am ENVIRONMENTAL <br />054AWaC S "Q� g OApOBT430EB3 <br />facie sPhau. HFAITN nleDe4�kA�"�tT <br />96, U.B. GOT 4eecAp11an pndudh+g Proper BhlpplRg Noma, Harsnl Gess, ID Number, 10. Cornekten 51. Val 12. UnN 13. Wesle Caries <br />Na yp WLNcl, <br />HM end p ficWng group 01 eM9) T o <br />t4ON -RCRA, HAZARDOUS kNASTE, SOLID. (OILY SOURS) <br />sxavls��sti <br />14, <br />Y <br />� 3 <br />SpodAl Handling Ict one and Addhionat u—n 10n ' <br />EPyC%Ei�CY GONiA4T O ENtTRFO 1-8()A24-9300 N E $Ol..01 , 171 i 9R2 :171 PROFILE #t 981: 23 <br />AP2008 . <br />Cry $0LJO'r 982: AP; 02W rjaml LATW-. SKAViNCS I P'G# hiu2oET�3 , AP'PI40MAT! RE SOMAL "JO r3*o�'" <br />R T>= IfltaP�iEsdT <br />4, <br />OVRATOR18ICF7RDR'S CERTIFICATIDN: I hereby dtalato dr,r ere mntenU of 11115 eonelgnmanl are My and ecaralely dawdbed sbova 4 the proper ebppinq name, and site dai;Wed, pecxeged, <br />marked end Ipbsledlpleo'rded, to aro M of reapeele In proporw4iilon 1Dr trenspM arpording to and nouohal govammaniml ragulaflont. It export ahtpmanL End I em the Prhnery <br />FxPoder, I oer$ry lhol the WNerris of tfilP Cole�9�+�I �m � � �m'e of Brs ettaohed FPAAcknowledgmenl of Cer+serd. <br />I candy awl Uro waslartdnlmitatlon tR10Merd Ids n<fied In 40 CFR 202.27(a) (III no large quarlUly pen or (b) (HI em a smog quenklty ganoretA 4 We <br />montreafUl)rttrc pdniRi0yped Nemo alp aD�rl, r <br />6.Iftnallortel ShIPM8Ms ] ❑ Exuart frrnn U.S. Pon pt enlrylW: Impod to U.S. �---� <br />Tmnspeder kvnWR (lot sxpole onty), Da a lesul U.S:. <br />17, Ira roporter Adlurovledgmenl d Rooalpl M Nararlals <br />Try j PnnledRyPod Name Blgnetu a nU1 qey Yetr <br />renspo r 2 Ptldte a t Signature Monlh . 9af Your <br />1B. Disuapenay ' <br />16a, Dlaarepanoy Indication Bpeca Ouentlty IDTyPa L.� Rcsldue ❑ PeNal Releclbn ❑ FuN ReJs*n <br />ManNtat Relarenoa Nvmtiar • <br />1 Bb. AMess+s FadMry (or ow alorl U.6, EPA ID Number <br />U , <br />LL Feogt t Pnnna: <br />IBC nature ma . a INy or ane onih Day Year <br />I j <br />1q. ii4woue Waste Rupon Manegcmonl s (i,t., oodo0v h4mMeua weelt Iroahnenl, dlspoW, end fegcling sysVums) <br />I <br />20. Doclo td Faellly Owner or, ©peralor. CNMcaW of rocalp e( hwrdoiis mEhilolt mvertd by the manlleet 0".1 N& nded In ltem Ov <br />Prin onaur e <br />-31L <br />EP orm 6700-22 (Rov. 3•D5) PreVOUS edlt'tone obsafele, bESIGNATECI FACILITY T ESTINATION STATE (IF REQUIRED) <br />