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Please Pr mtor type.(fWm designed ioruse ort We 12.01ch} xri;er.) � L <br /> 1.G'anerar�r ID KwnWr Approved.OMB No.2050y0D38 <br /> UHfFOR! RPYARDOUS 2 Page 1 of 3.Em sncY Response Phone A Manl[est7rasking Hum or rn� �+ <br /> WASTE AIANIFI S7 CAD98313fl6g3p 1—'� 209-9314204 U O �,4 L G B <br /> 5.GereratufsHarrts8ndldrsTrtgRdd+res Gercrators56eAddress{ddlTesenllltanmaTa►gsdd 15 <br /> ASSOCIATED TRACTOR SERVICE,p4C. f <br /> 1323 W CHARTER WAY <br /> STOCKTON,CA 952()5 ; <br /> Genera:er's Pnone:209-486•3803-1 O5 <br /> fi.Ttarappr'er 9 Y�e <br /> AMERICAN VALLEY WASTE OIL,INC EPA IDN�nLer <br /> 7.TrarsporterYCorripany Name CAL0p0419714 <br /> 2191 Century EnWrOamental Management of California LP U t AIA rh�rrther <br /> 8,0esi,MW FaZ,Name arta 0;VrA u"ls CAR000210517 <br /> 21ST CENTURY&MRONMENTAL FdGMT OF NEVADA,LLC U�@PAfpfJumber <br /> 2095 NEWLANRS DR.EAST' hiVQ$$U88533g t <br /> FERNLEY,NV 8940a <br /> FactFtys Pftone. 776-575-2760 <br /> ga, Bh.US.DOT Despipliort{ndadag Prapax 5hiiAn4 Name.Hazard txass,I D l�rpnbgr, <br /> HFA andPaCltrtgGrouP(fanylY SD.Corta4lers t1.7ntal 12.Vok <br /> 1. f <br /> No. Type ow* W[Nol. t3.Waste Codes <br /> RQ.NA3077 HAZARDOVS WASTE,SOLID,N.O.S.,9, <br /> PGI4.METAL GRINDINGS,f1ZON&STAfNLESS i DM 48 p DO D008 i8i <br /> to <br /> w 2. <br /> to <br /> 3. <br /> a, <br /> 14,speaal Hard5r�g E90) <br /> pP�tOFILE#7EFAL GRINDfNGS,ERG#Sri <br /> E1+MENCY <br /> 75. GF kEfiATDR'5lOFFERO}i'S CERTiFICAT1pH: I Ile <br /> rebydedare that the Wnlenfbof this GGtts grvnerdare <br /> maAcedandtabetedrpPacarded grad are in aflrespeCs n prcPuaatldrrips far lranEport ao�rdrtg tvapp[iw3[e fnteatasndna5onabed aUevtrby the RaPeraTiPPatp name,ardere dasai5ed,parkageo► <br /> Ear PaerOfyttrat Uta oon ertfs of this oons�yrurterktnnform to thetomp ofthc atfar]wd EPAAdonowladgrhml alCaasePtty~tw regtdaliora nexpvrl s7trrrenl and I am idle Primary <br /> mfly Ilialthe waste mrimaalKn atatemerttM"0e4 Pr140 CSR 262.27(a){if t am a War15SS 9a (di am a sinal <br /> Genere5?I5J0 •Eedlrl'r�Hame '� Qwr&yafnr)is true. <br /> I0yea17 MWth Day Year <br /> LA <br /> r❑EVMfmmU.S. Podderrtrylea,oaw u.s: <br /> PW <br /> Z ft2 <br /> OE itea, <br /> to ll�cepaney <br /> 18a.U6scrapanry 4t&xton Space �Own6ty ❑'type ❑Resdue ❑PartislRejet:6att ❑Ful Rejetdora <br /> 185.AC,ema�F�pTAy(o►Generatcr] t�lad;aat ertxx+eMrmher, <br /> U.S.EPAIDfJumher <br /> Q <br /> Faatys Phone: <br /> Q 18a. tgrrsarroofWlemate acuy(arGeeeretar} <br /> x Atortth Oay Yoa7 <br /> w7A.Fiaterdou=Waste Report rJanagernent ANON Codes¢e..00des forhaTaaiouswaste ueamkn4 <br /> andrecSdm9 sy�emsl <br /> 3. R. <br /> Prn;nYCYPodN2rne Oder��� Gon W re�eipol+arardaus mat2riais oarered by the rrtanr[esleaoepl sand Vera 18a <br /> 20, <br /> EPA Form 87&22(Rev-"S)Previous e0oas are ebsorele.SE P p <br /> -_ 0 12016 <br /> DESIGNATE]FACILITYTO DESTINATION STATE(IF REGUIRED) <br />