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<br />Farm Appra.ed OMB Nn. 2050-DO39 f Fxpi<es 9 3D-991
<br />Plante print o See Instructions on back o ge 6
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<br />o, USA nn elle (f 2•pirc.., ,y1.1trwriter.
<br />UNIFORM HAZARDOUS I Gw,wulor's US EPA iD No.
<br />WASTE MANIFEST
<br />3. Generator's Noma o,id Mai Ping AC)rl.ess
<br />013 REBUILDERS,
<br />2325 W. L'I'iAF TER WAY
<br />4. Gencrator't Phone I- )
<br />19 4)57-1190t
<br />5. Tiunsparter 1 Cnnipony Nome
<br />%.
<br />Department of Toxi< Substances Control
<br />-- _ Sacramento, CaWarmu
<br />Manifesr Document Nu. 2. Page I Informnlian in Iha {
<br />a wded grans
<br />is not required by Fed-ol law.
<br />of
<br />A. Sfata M4nifml Document NUmber �
<br />X98:4953
<br />STOCKTON r CA 95205
<br />6. US EPA ID Nlnll6er
<br />Y. Desirl nolnd hacilityNr,mr�an�d �Sesi�so Address 10. U5 EPA ID N
<br />ff�y, umoer
<br />3550 2(�,rH
<br />3 tJrrOaL s CA x
<br />1 I. US DOT ❑"a ,i tion mchuEn Pr V - r _T`
<br />p I g aper Shipping N< v, hazard Class, and ID Number)`
<br />N
<br />lir1e".AFc1iOUPS WASTR SOLID N. 0. S (CA.DMZU'M
<br />C'MOMIUM ) r , KA, 3077 J)rI i I (D007 , )008 ,1)006 )
<br />NON RCRA HAZARDOUS WAMS LIQUID
<br />(OILY SrttD"F )
<br />C. ._
<br />J. Additinnnl Descriptions Fne Moterials Listed Abn.e
<br />Ila. 3na 5,x_0•;
<br />111). 300203-02
<br />15. Special HanrlGng Instructions and Additional Information
<br />9TROPRIATE CLOTHING?
<br />"tote Ggnerator's ID
<br />TranspaHer's ID
<br />D. Transpoeler's Phone
<br />E. State Ttansport."s ad.
<br />F. Trnnsportar's Phone "
<br />G. Star. Facil'
<br />itys ID -
<br />H, focitify's P{,ane
<br />14. iorai i4. lJnd
<br />Ouantiry Wr/Val I. Waste Nun,lrer
<br />Stole
<br />State - - -
<br />EPA/Orhe�-
<br />-
<br />I_I I Fpq/Other
<br />. H . _
<br />5rot.
<br />� I EDI
<br />K. Handling Co..l1 I cs for W -tri Listed ahave
<br />a. 6
<br />24 HOUR EMEKENCY REMXXJ P, --
<br />C -M TFJ,, INC, 1-800-255-3924
<br />16, GENERATOR'S IfERTIFICATION: t Ly�ehy declare that the conrents of Ihds..—)V nment are fully and occurntalyy-described (,6 a by propwshipping name and ara,�lossified, ackad,
<br />marked, labeled, p
<br />and nm) ore in all respects in Ivoh«. «,r diliun for transport by highway according to applicohle international and national government regulations.
<br />IF I am a I ... ge quantity penaridor, I certify that I have a
<br />pros :..,, in pluce to reduce the volume (161) IOAicily of waste generated It, the deglx« I have dnlaiv,ined to be.ranomicall
<br />I,rachcable and that I Irave selected Aa pee, iwbfe method of treatment, storage, nr di.pvlal currently avoilnl,le to me which minimizes the present rind future thrant tv human heahh
<br />and the an.6unmem; OR, if I --, o small quantity gcncrator, I hove niude o good faith effort to minimize my wasta he,t
<br />ovcnlable to me and thof I can afford.
<br />generation nod )elect the waste Management mathoCl that is
<br />Prinird; typed NmmA
<br />Si n to -�
<br />l Irr 1 Acknowl»rJge nt of Rcc ���nE Materials
<br />��
<br />IIr M nI{, Dn Yiniea
<br />l .s�, 0.
<br />Prinrcd/Typnrl Nume
<br />j � r /t � { 1. f-
<br />.•
<br />Signal reDa�
<br />%G'sF� �•�,.�_ _ _ ..
<br />M th a ,r
<br />1 A, T.ansportcr Lnvw
<br />�~
<br />C✓
<br />2 Ar edgemc of Rl of Materials
<br />Prndrd/Typed Nmne
<br />Signature
<br />_...
<br />Mvnhh Dloy Year
<br />19 ni.crepancr I..dl..aivn Space
<br />---
<br />I I
<br />20_Facilily Owner or Operons C,«,hLcotion of receipt of haznrJa„> n,11.dab covered by this manifest axcapl vs noted in Iter 19. '—
<br />Prinlcd/Typed Name Signature Month pay Yaor
<br />DO NOT WRITE BELOW THIS LINE.
<br />Ychow GENERATOR RFIAINS
<br />
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