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X7-1-1 � 00 l 'F r =U fk.20K-W39 <br /> Please print or type. <br /> 1.�"Nuedrer 2.page"I of " E 4.WarAest Tracking Number <br /> �w�sEIFESTg CAf_ll035aF3i y 1 1007181976:.I�� o SKS <br /> 5.Generators Nam and MaiEiftg Address Geriemlors Site Address(d different nap mg*g.g address) <br /> D & D Lift Irtf" <br /> 3820 Rhonda Way <br /> TRACY CA 95304-1608 <br /> 6.Tran U.S.EPR IDNumber <br /> SYSTEMS INC TKROO1�R'>?715 <br /> 7.transports 2 Company Name <br /> U.9.EPA fC NtrVxv - <br /> C1_EAN HARBORS ENV SVC INE. MAD027 a-' -250 <br /> e.pm4wtedFacifrty Nare aWSkeAddre% CLEAN H013ORS: SAKI JaSE US.EPA ID - <br /> 11 BERRYESSA ROAD <br /> SANJa�E �� ��i� <br /> Fadity'S('frons; <br /> 9a. 9b-U.S.DOT DWnpson('&*V Proper qWpkq Name.Hazard Class,ID NoTber, it f;o'ums 11.TOW 12.Uric <br /> HM and e (r wvO No. Type Ouaft MAA 13.Vitaste Cotler <br /> ' "dL7�+1 RC?A HAZARD" {,ATE IZ35 DK p P-23 <br /> o (DEBRIS, PETRDL.EUM HYDROCARB0061 <br /> w 2. h 0+-RCRA HAZRRI Oi !S WASTE, SOLID � DM � P 223 <br /> a FOIL FILTERS) <br /> 3. <br /> 4 <br /> 14.spaa;il Hanaling 1n51nr rims and Add€Wal Wonnnabon TSD:SJ PiiA,,,t-.84543 DD02763 CSG: <br /> 24H E14ERBF- 1CY#800-468-1700--CHISK/TFI-Contract retained by gen rel r anerr a envy aut�lari y <br /> 15. GENERATOR'SICIMROFUS CERTIFICATION:i heretty deme that file rodents of fids ON signmerd area 4 and aianw. ly dasaibcd atrovsby t to 0ow suing name,ars(we daswiied,pwkagerf, <br /> marked arid IabrJedfplacarded.and are in d respects in proper cmcitlon Tor bwtsport acceding to apdt able wftnailional and+rabarpai cgmwn nmW regi lion s.R erporl sroorrem and I am the Primary <br /> Expurler,I cerify that the c"M of tlis consignment oca tom to the kxms of the attached:EPAAdirnoxle#rwrt o(Cunswl_ <br /> 1222t that the waste Tanimeatrota stat w idenbfled is 40 CFR 2&27(a}(d l am a taV q Ny or(b)(if l am a sinal <br /> mss - <br /> Abfih a3Y 1'ew <br /> 116 IN III'? <br /> 18.�e Sliatlents <br /> y,,, ❑lmpOrt b U.S. ❑F�'.yort(ran U.S. Pon of enCyleriL_ _.. <br /> Transporters 9rsature(tore ons any): Date U S.: <br /> W 17.Trarapurler Admowledgment of Receipt of Materials <br /> Tran t PrTped Sgtethxe Month pay Yea( <br /> 6 jo i <br /> r 2 prinied.Ryped Name mon!h Year <br /> 18.Dwepancy <br /> 188.Disacpencr h dication Space 11 Qtty ❑Type Q Residue ❑Partial RejeClJon r Fuu Releaon <br /> Maniest Re�rerr�then6er. <br /> 18b.AlRMWQ Facility for Generator! U.&EPR 1p hu ber <br /> {W <br /> 18c Slgnahrre ofMamafe Farslity Of C—orator} aay Year <br /> z <br /> 19.Hazardous ftwe Report Menagemerrt Method Codes(i.e.,cooea for hazardous wash beat—me dispasai,and r-oirg systems] <br /> 1.Or� l12- <br /> - <br /> #. <br /> 201,Oesp aced Fac*Owrraror Oparabr Certrem <br /> pt of repl of hazardvurs.mtt(ak caged by toe mar*9 pt as n ied in Nem 18a <br /> t+Aw <br /> P' Name - <br /> . _ rttr war <br /> ' <br /> EPA Fm 22{Reu.12-17} Pr bans are ohsatete: ! [GIW4TED FAGIUTY T4 ERA's aNCAFi#F1=ST SYSTEM <br /> . .'i 2',7612003/15C,771 <br />