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W 11/25/2015 WED 11:21 FAX 2099704469 SerViCeAdminMFD <br />012/014 <br />Form Approved. OMB No, 20500089 <br />Please pAt or Form daa ed for Uoe on 1 h (12-pllCll ewdtAr. <br />UNIt`ORMNAZA,RAOUS l.t3enerelor er <br />2. Pepe 1 of 3,E1 Reeponas Phone <br />' 424- 9300 '. <br />4, an oat Ua ng Num or(� �} �j �[ <br />' 014051 <br />WASTE MANIFEST <br />C A L 0 0 0 3 6 0 � 0 <br />5 1 ., (800) <br />V L. C 1! <br />Oanarasore 5Ra Addreae (!I � ,erent Than ma'�ng address) <br />' <br />,e��2i���,II3C,0I,N <br />I'. O: BOX 690398 <br />x979 AUTO Cl' lr rR y�TACLLci <br />STOCXTOW CA 95269 <br />STOCKTON , <br />2(19 7 3 —1311 <br />na ror s Phona; ` <br />tanaporter owpanyHame <br />, . EPA ID Nu r <br />,� <br />?BURY �1V'TRONML�1'T1�T. $EAVICEs <br />.. <br />.S. EP D mbeT <br />7. Tran W4r gmpany Name <br />8't)at naiad PerAl N—emo And S k dreaaNov <br />, <br />�Ft ITA �P.T�R TECHI+1�Jt�OKES LLC <br />_M!) <br />U'S. VA ID Number <br />5 51 0OUTH BOYLE MW= <br />LOS .ANOBUS CA '90Uir8: " <br />[� CC�1 hh�ww h�I <br />F�.NV�nV�vavi�N��l� <br />C� D 0 9 7 0� 0 •5.„g 3 <br />FacYi op”! " (3233.277-1500 <br />ro T <br />- <br />ga. St, U5.0'OT aeaafp9oh (IncludIQ Proper Shippino Name, Hazard Clud,10 Number. 10. Cenlekrers <br />15. Tcta1 12 Unit 13. WaIa Codas <br />OvermN McII, <br />NM and Pa*rg0toup(Keny)) <br />No. Ty <br />1NON-RrM Ii ARD013S WASTE, SOLID <br />(BRAKE LATSL <br />16X <br />ca <br />IMERGrkY CONTACT i Cwm= 1400424-•9300 N?,EPD -9B1 A 1?1 * .PROFILE ! 9BI f a. <br />AP2.029511 BRAXE LATHE SHAVINGS * PDQ A110212630 * APPROPRIATE PUP . At TkOTIOTJ <br />t6. GENERAMR'6MFFEROR' $ CPRTIFICATIM. 1 hereby declare that fie wdenta of IMa conebnment era o'N" <br />Uratgty deecoad above by a)e properahWIn(rnama; and ere dauMaad, packaged, <br />melted and krbeiedlMmerd4d, end aro in aY reopeola In proper eond4on lot 7enepcn according W appllcable m o and nWN nal govarnmdrdel MouleUone. If eWart Bhipmegl and I am the Primary <br />&Kder, I carily that Ula coloots of Ws oonelgnment cankrrn to the imme of the atimhad EPAAcknewledg eM o Q nI. <br />I ally thsl the walla MNMIzalion atMernw Idohi lod In 40 CFR 292 27(a) (N I am 141" quantity goner or (( m a ImeW gwrwhV generator) It true. <br />�� U Impart to U.S. LJ Expod tom U.6. 1: Pori ot'Brrhprdl l <br />Tr'ansportar aIgnaturo (br axpada ony): Doha leaving U.S.- <br />P1 17, Trenapater Acknmvledpnrent ai Recelpl of Matodels �.-�� <br />V/ <br />to. Diecrepency I�---{{ <br />1$e, Discrepancy IndlcaBon Spew 114uenpy LJTwe ❑ Resltlua L._1 POW Ra)oot(on ❑ Fuli 41d, <br />ManUeat P4147Ivunber: <br />lob. Aliamate Fa&ly (or Ganeretar) U,S. EPA m Numbar <br />FacN( s Phone: <br />15c, bignalire o A lemats Fwlky (or nerato onl I Doy Year <br />Hazy OL4 Waete Report Manademetd !Method Codes p.e., codas for hazar(Joue wase 1repftht, diWoaol, and moyding ayslane) ' <br />Ln 1 2. 3. 4. <br />20. Dovionated Facllty Owner Ir opemtot: Ceftatlon of reoelpl or hatattraua motoriala covered by the manllaat exoapt es n0ad In Nark lea <br />do oC me+ ,,I re nth 611 <br />b`L,a,t_-Xf .4,t 1 ^��n Q ac,-� l -DY116 1 /9-1 <br />EPA Form o700-22(Rev,3.05) PreAvuse(Mlonsare obsolela, DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRFO) <br />