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12125530 PUn)Ithred by J. J. KELLER & ASSOCIATES. INC, V, Neenah, WI t USA • (�9 09 'IN . � d l : � m O 60 i Ir 6 6 u fl r Iq 2 Ua I 1 P ;A I 0 2 � C 6 11 <br />Ple�ssiprinl or type, (Form designed for use on elite (12 -pitch) t pewtlter, <br />UNIFORM HAZARDOUS 1 1 oonerator ID Number 2, Pege 1 of 3, Emergency Responae Phone <br />WASTE MANIFEST CAL 000 340 085 1 916-849-0144 <br />61 Goneralor's Name and Malling Address Gonerotofa Slte Address (il dlAernnl I <br />Beckor Trans m ion & Auto Repair <br />334 E. Lockeford St. Lodi, CA 95240 <br />Generator s Phenol <br />2Q9334-5824 <br />61 Tranwrler 1 Company Nama <br />SACRAMENTO WASTE OIL <br />Worldwide Recovery Svstmes Inc. <br />Yuma Yes 2 Waste Transfer F�ac:l.iity <br />6500 S US Highway 95, Yuma, Ar:i,zonri 85365 <br />=ecg1 'a Phone: 928-344-9828 <br />ga 1 gD. U,S, DOT Description (Including Proper SNUpinp Nema, Hazard Clans, ID Number. <br />HM I bnd Pnckln0 Group (If any)) <br />ilON-l2CRA HAZARDOUS WASTE SOLIDS <br />(Oily Solids) r <br />IiANDT,FRS TO B1J' TRATNEu AND USE PPF <br />Form Aperoved. OMB No. 2050.003 <br />CAT, 913 534 912 <br />U,S, SPA Ip Nlimbar <br />CAR 000 175 422 <br />Ds, tPA lU NumDor <br />AZR OOU 521 146 <br />10. Contninoro 11, 1Dlai 12, Unit <br />No. Type Ovonllly wuVol. 13, Wasie Codea <br />18. GENERATOR'6IOFFEROR'S CERTIFICATIONS I hereby declare Thal the coolants or IMs conslgnmonl ere fully and <br />marked and labeled/placarded, and oro In all respects In proper condllion for ireneport according Io appilcAhie Interna <br />Exporter, I certify that tho contents of this Conslonment conform 101110 terms of Iha attached EPAAcknowiedgmenl of <br />I cagJfKthet the waste minlmizatlon staloment Identified In 40 CFR 262.27(8) (if I em a large nuanllry oonerator) or (bJ <br />il, Transporter <br />I�I Imporllo U.S. <br />exports only): <br />groom of R8c01Pl of Motodala <br />b�rC M. Hern.aadez <br />ExDon Iroin <br />3 <br />( <br />�t tj i <br />352 <br />desGiDetl above by Iho proper shipping hams, arU aro Olaesiged, packaged, <br />national gareromegtot)regulatwns. Itexport anlpmenland I amthe Primary <br />a small <br />Pori of BnlrylexiP. <br />bele 19AyInU U.S.I <br />Is lNe. <br />16. Dlecrepoticy <br />19e. Discrepancy Indlcatlon Spacn � Quantity ❑ 7ype ❑ R691UUtl ❑ Patllal ReJectlon <br />Manifest RAlerOnce Number; <br />18b, Allernale Facility(or Ganorator) U.S. EPA ID Number <br />Phone: <br />1U, Wezerdoue Waste Ropori Manegemeni Modred Codon (Lo., cotlos for hazardous waste tmaUnonl, dlspooel, and rocycilnp systema) <br />20. Daslgnatod Facility Owner or Opamror. Corlincotion of reeolpt of hazardouo metvifolo coyorod by IN manliest oxeop( nc nood In Item tee <br />nted om <br />pe a gnalure <br />I <br />C /Z aZE) ci COL9bCC60Z X QNV NOISSIHSNK 11 UHHOHEI <br />L <br />fear <br />❑ Full Rejection <br />T^Id 9fii�T0 OZOZ"OC'unr <br />