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07/30/2008 08:51 FAX 91 25547 DTSC-GISS 1a003/003 <br /> DTS.C. GQQ82. 2273 <br /> Pease print or We.(Forth deslaW for use on elite(12-pitch)typewn2er.) Formved <br /> 1 .OMB No.2050 op3g <br /> UNIFORM HAZARDOUS ' r 0 2 0 7 5 3 3 2.Pagil1 of 3. 4.NNsnN Tractlng Number <br /> WASTE MANIFEST . 000267710 JJ K <br /> 5.Genem D(s Name and MaOlrg Address Geareretoya Sae Ad�ass(d alfte ant tlharr m""g address) <br /> DSS Coad metian 639.W. ClSt.. <br /> 639 W. Clay St, Stockton, CA 95206 Stockton, CA 95206• <br /> Generator's Phone: 209/948-03 2 Greg Silva, <br /> 6.1ransparler1 N <br /> . Iff.UAA AN Lr 0 0.0..2 .1 3.8.81 <br /> ,INC.. U.S.vS <br /> '=,•.: .'.. '. .,, . . . <br /> 7.7rarupo tar 2 Company Name U.S.EPA ID Number <br /> B.Deslgrhated Fariity Name and Site Address <br /> Us.EPA ID Nraida <br /> FORWARD LANDFILL INC,.AUnWR0 •MA�'I7rCA,;CA 95336 <br /> Fedi a f�hate: "(209)982-4298 ' ,. .. C:kL p.1.p p i g a 0 8 '0 <br /> 9b.U.S.DOT Descripton()hdudirhg Prophv ShWb19 Name,Hazard tom,M N'timbey, to.Containers <br /> HM and PacWng Group(d nhy)) 11.a I hAry� 13.Waste Codes <br /> Na. Type <br /> 1. <br /> Cr <br /> RQ.-ASIMMS, 9,NA 221x;PQ III(ERM171) BA 151 <br /> W <br /> 3. <br /> 4. <br /> 14.Spedal-..dl I s a dwcnal Info <br /> 9 XsVe`�osr�l emo equirement 40CFR61 (B ed and Sealed mad Labeled)}.Em en <br /> Response number i9(209)524-061.1: REMOVAL CONTRACTOR•IS ETA . INC., <br /> POST OFFICE X 3958,MOD ESTO CA 95352. 209).524-0b12;,r", (JOB#;55551.0 <br /> s Db N BAOS i' . Lr. <br /> 15. GENERATOWS/DFFEROR'S CERTIFICATION: I hereby dedere that the awrtents of this cong4punent are fly and aoauetsly desait)W above by the proper ehl"name,and are dasstfied,packaged, <br /> marked and labels tAcardsd.and are In a0 respects In Proper condition for tran <br /> Exporter,I that the conlanta of this const Wort chert EPA <br /> A aPplicabie Irterrhetlonal and national govamrnentai regumtbrhs,t export shipment and l em the Prtrnery <br /> �' gnheM conform b the Earhns of the attached EPA AduawAedpneM of Consent. <br /> certify that the wa61a m1nlmlzaton statement Identified in 40 CFR 262.27(a)(r I am a large qua"garerebr)or(b)(t 1 em a smell Quantity generator)Is true. <br /> Generatof ys Pd rtad7T Nemo Month Day Year <br /> �r- <br /> � 16.International Shipmerhb 11 I d pp U <br /> Y 7w ❑&,ort from U.S. Port of enb wet <br /> Transporter signature(fa exports only): Date leaving U.S.: <br /> W17.Transporter Aduwv tedgnent of Receipt of Materials <br /> OTransporter I Prtnted/Typed Name SIGnature Month Day Year <br /> n. n _ L <br /> ZTrsporter 2 Printed/Typed ame Signe <br /> anIJA <br /> Mhxrtlh y Year <br /> 18.Disawancy <br /> I Ba Discrepancy Indication Space ❑ Quantity ❑Typo ❑Residue ❑Partial Re action ❑Fu0 Reject.. <br /> y McNfast Rete—number. <br /> S 18b.Alternate Fooky(or Generator) U.S.EPA ID Number <br /> U <br /> LL Fedlit)/s Phone: <br /> 4Pj 18c Signature of Attenale Featly(or tor) <br /> Month Day Year <br /> yIN.Nazwd=Waste Report Managenwt Method Codes Re.,codes for hazardous waste treztmwl deposal,end mcyrfin'g"am) <br /> 0 1' 2 3. <br /> 4. <br /> 20.Designated Fenny Owner or Operator.CaTocaton of receipt d hazmdaz metlufals covered by to manftdat except as ndbd In Item 18a <br /> PrtnWdfTyped Namergn" Month Day Year <br /> 1 <br /> EPA Fain 870422(Rev.3-05) Previau editions are obsolete � t) <br /> 000342035 DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> . <br />