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rypa.(Form da { q )ypa ) FemT roved.OMB No.20.50-00.79 <br /> Please print or sgnad is use on elite 1"•7ch, writer- e '� <br /> UNIFORM HAZARDOUS 1,Goneratw ID Numoer 2.Pape 1 of 1.I-,-,,Response Phone 1.ManHesl TraGdng Number G B F <br /> WASTE MANIFEST CALOW316058 09.334-3.396 003 5 29518 <br /> 5 Genereto"s Name anti Mailing Add— Generators Sna Address ill ddRMM than me7lrrg addressl <br /> ACME SAW&SUPPLY-LODI <br /> Y 14 N.SAGRAMtNM SY <br /> LODI.CA 9524i1 <br /> Garnami s IUky-334-3.Ti9S <br /> 6.Transpottm 1 Company N—o U.S.FPA ID Nunbar <br /> AMERICAN VALLEY WASTE OIL,INC. CAR000272302 <br /> 7.Transpaw 2 Ca pang Name U C.EPA ID NUMW <br /> STERICYCLE SPECIALTY WASTE SOLUTIONS,INC. MNS000110924 <br /> 8.Desgnated Fadlry Nam¢andSite Address U.S.EPA ID Number <br /> CHEMICAL RECLAMATION SVCS 7X0048844700 <br /> 405 POWELL STREE F <br /> AVALON,TX 78823 <br /> Faokwe p,_,972-627-3224 <br /> 9a. 9h U.S.DOT De Ic Uon gndAN Roar SlkppN Nacre,Hazard Class,ID Number. 10 Containers 11.Total 12.U!1it 13 WasW Codes <br /> HM F.PadCng Gmrp(r'any)) No Type O_by WtN01. <br /> X ! RQ•UN1993 WASTE FLAMMABLE.LIQUIDS.N.O.S..3,PGII, 1 DM 55 G D001 0018 1 <br /> o GASOLINE,OIL OIfTS 211H <br /> a 2. <br /> w <br /> 3. <br /> 1 <br /> 1a.Spec.Y Harrill rrtl insmaropns W4 Addroc Inb—w <br /> PROFILE#91530600 GAS&OIL ERGM128 <br /> EMERGENCY CONTACT:JOHN <br /> 15. GENERATDR'&GFfEROR'S CERTIFICATIGN:I hereby d^_c'erc tRet the canl¢nts of IMs o:xnigraren:ars luty and axtiB;ey eesdltwd above by ere pmpar enipl»,g mann,aro are ckess?ed.packaged. <br /> marked and Wosled;ala;a'dw and aro m all raspeols m poser candRu ,kx n sen".accvdmg:o appFcebie intemAb"and raWMl governmenw negotiations.it axpoe Sf a, ert and I IT Inc P"n <br /> Expaler,I MIy Run IN,contrna M the an09 v t anlorm w the tans of he aeachcd EPA AcknowtedgTeM of Consent <br /> I cerbfy mal ma waste mdmWt.o satemenl 41AW m 40 CFR 262.27(x)Ill I am o lave quantHy generator)or(b)(id I am a Small q�nlity generabr)N brae. <br /> Generator'S70¢ra%PrinteVy a Sgnature MM% Daj V�:; <br /> 1 L/i <br /> n1errwbi 4 —M, <br /> ❑Vmpwlr U.S LJ Exptxtf. '.S. Port of ertyledt: <br /> 16.I ..._. _... ..... <br /> Tr>nsrwr:ersq.lure!V espors only) De leavmg'U.S.. <br /> pW[ 17.frxsspwea AdNUtlnfglneM 01 R�r.iq N llenrals <br /> 'yy.Tra 1 Pane Nem ��7 bY�y <br /> q rs <br /> a Tra+spo 2 PMtedrt Nam Sgnatu+a �a�rx^, P y Year <br /> a � <br /> 18.DiScrepa�nY <br /> 18a.D-ep."lndieado,Spew Doanby r,Type U R-sk­ L.1 PaMA Rl.R.turf ❑0.A Rejecb'op <br /> 9.0.1 Releranw Number: <br /> tab.Aherwte Facddy lar owt.1 r'1 U.S.EPA ID N—oo, <br /> 3 <br /> U <br /> LL FaWly's Pha+a: <br /> w t6c Sgoatu e1 A1:—Me Fadi!fy,tnr Cxneretcv) Mmtr. DaY year <br /> 4 <br /> Z <br /> 15.H ardour West¢R,,W ktanagemll McPmd Codes(11,mdse tw Weed—wash Leelment dlywsal,-M-0-v systems) <br /> 20.Desgneted Fadt!y Owner w Crnt r.CaniE:X"o1_juj o1 Iw wdN malerlal;-ad by the m. gest ezce 1 as Med n Rem 18a <br /> :Md <br /> � d' N Al Mp1'R Dny T, <br /> FPA Fwm 70.0-22 lRev.3-W PreWaus editions are obsolete, <br /> DESIGNATED FACILITY TO DESTINATION STATE(!' REQUIRED) <br />