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'for type.(Form designed for use on eMe ,2- h ler. Form Appmved.OMS No.2050QM <br /> .AFORMHAZARDOW 1.011 DN4.Page,d 3. ° <br /> y 1" 0'1'34152914 JJ <br /> � CAR0 0 001 55 BQ 1 9� <br /> I -CG- REBS CO INC wM INC <br /> PO BOX 2559 BEMER DRIVE <br /> MANTECA CA 95336 t019 MANTECA CCA 95338 <br /> r�eneemry Phdrx 2 0 9 823 - 2 1 6 8 <br /> 8Now U.B.EPA D Nranlw <br /> ENVIRONMENTAL SERVICES INC C A R 0 0 0 1 7 1 0 1 7 <br /> 7.TratwWW2 'rNo,ra <br /> 8.DelteaMflM 06B Address U S.EPA ID Number <br /> HWY 9511 MI S OF CY 16 ACRES <br /> BEATTY NV 89003 <br /> Facil Phone: 775 553-22013 NV T 3 3 0 0 1 0 0 0 0 <br /> 9& &U.S.DUrDmIlIftnPultis:111IMPNW1111111W9111loW famed ckw lD Naeber, 1111 Coatesville 111.w 12.uhdt ,3,Wade Cadet <br /> HM ane pleft OU4 IIIII'M A No. TO ! W Md. <br /> 1 <br /> ABSORBENT)HAZARDOUS WASTE,SOLID(OILY DEBRIS, 223 <br /> 5111 jo <br /> 2. <br /> 3. <br /> 4. <br /> 114 ora 171 <br /> EMMUMS11c Spy >���$iadst #205N7�»� <br /> 15. GENERATWSWERDR'S CERTIFICATION:I hereby declare that the=dents of the oarwi®nmerx are fuly and acoreffily described above by the proper shipping name.and aro dmiliied.padmW. <br /> madw d and labaledlplacarded,and are In al respects In proper oanditlon for transparl sccording to applicable intemabonal and national garammentai regutations.g export shipment and I am the Primary <br /> Exporter,I cer*that the contMts of This ctnxsignmerd conform to the Terms of the attars EPAAdmowledWent of Consent. <br /> I ce"Ihat tib waft rrdnirnkation statement Wenttfred In 40 CFR 262.27(a)(N I am a large quantity generator of I a arrwl l quantity generator)is Inns. <br /> Month nth Day Year <br /> E 2 <br /> 6.wamilml S19pments <br /> ❑Import to U S. ❑Export from U S. Port of entrylexit <br /> Transpader sa�sabxe(foraxpoM Daly) Dae Waving U S.. <br /> 17.Tresnporler dReoriptdMMerWe <br /> Tranepolbr 1 PrYdeQfyped Nemo Mads OW ym <br /> 1111bkErf 121d <br /> MOO Dry Yw <br /> ,a. <br /> 11AL rs"oe Space ❑ � 1:17* ❑ROW, ❑ParBel ❑FIA Iie1-don <br /> MarlifrW 11111haince Number. <br /> 1Eb ANarrtele FacSgf(ortiarrarebr) U.B.EpAS <br /> es. r Plane: <br /> ,Ra SlIallum WAierrmer Dw Yw <br /> I1 IOL tli nb Report M*W Cede pw.aedee for htrsadoue vele IkeWa% T paei artd wffi frtp eye0errw► <br /> •� 1 <br /> T <br /> 4. <br /> - - <br /> 20. fFa fJ70awaropaamrC IN 0anawoMptatha doss- IsAeta byth NMete>rolptsrridedIntlsm,ea <br /> t reAIM <br /> EPA Form 8700-22(Rev.3.05) Previous editions ars obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />