|
t a ® EMuonmertal Services Division
<br /> •t
<br /> CA MW
<br /> Malting:P.O.Box 176,Sallde,
<br /> Environmental SoMces Division Mal
<br /> CA 4 MaDInP•P-0.ept176,5a0dgCAeA68 �® Consolidated Manifest Pal 1 Oral FAX 6-M41
<br /> /012 KWnum Court,SWkb,CA9A6°
<br /> Consolidated Manifest yEPAk DARO°°°4701'
<br /> P6orhr.2W545-079t FAX 209545.2211 .~ h2'rnolaUy Paoouel3 eorr•ANr Invoice CATn..q rNumbn3644
<br /> .a74eor.aaN hwoaUGTs teyh•A.4m Invoice EPA�CARD°°°q°tae CALMsnsa E75H51D
<br /> CA Tnmp.rter NmnWrJDA4 1 _ ,___.. _
<br /> tATOR DA.u uae75D5,9 GENERATOR: invoice No- 40000390
<br /> InvoiceN° 400 0 0 3 5 2 Site EPA IDT.: OCC invoice Date: ��-
<br /> Invoice Data: �2 —' Contact Person: Driver Printed Signature:
<br /> DO—Printed Signature: S I Name: 'L N
<br /> -ZTruck C: Z'L—
<br /> t
<br /> Truck#: Z-1- Address: 1n C .V0. PO C
<br /> 20 W Cl POC i City,State,Zap:
<br /> 2 p:
<br /> SitePMre: MRMS-
<br /> _TgRMS
<br /> Product Shipping Name code CA Manifest 00 chmetty Unaa Price Amourd
<br /> Product Shipping Nam. waa1. CA
<br /> core Maniimt g0 Owntlry U.I. -Price Amount -` Nor-RCRA Hazardous Waste Liquid(Usd 0:Lubricating 221 " ! t3c-) Go' 35401161
<br /> GS. `
<br /> lA Hazardous Waste Liquid(Used Oil):Lubricating 221 / J 6 7 `6 S� UV l� ov Gal, � ,f Non-RM Hazardous Waste Liquid(Used W:Industrial 221 cal
<br /> A fiazartlous waste Liquid(Used :Industrial 221 GW Non RCRA Hazardous waste Liquid(Used Auanlotiue Antifreeze) 134
<br /> 134 ccw
<br /> A Hazardous Waste Llqu(d(Used Automoti�x Anttaeze) ,l �I
<br /> ;' ', Non-RCM Hazardous Waste Liquid(Oil d Water) 223 wt
<br /> A Hazardous Waste Liquid(O0 8 Water) 223 Drum(q
<br /> e>t t Nan-RCRA Hazardous Waste Solids Contaminated wit Used Oil 352
<br /> A Hazardous Waste Solids Contaminated with Used Oil 352 Drumla) y Drained Used OQ Titer Drum(s)
<br /> used 00 Flt ter Dmm(s)
<br /> Empty Drum(s) Each
<br /> ,m(s)
<br /> Each Transportation B TnlckTime HR
<br /> anon&Truck Time
<br /> i
<br /> llNaez w,.mbe apadead o.ndac.:ormme w.nem aecdpcPmam)T.mc Arcwmm au.arm.hon ovum narEn loa..Me.w.Urapurcturo.vast dee Total {/7�•D-
<br /> spedfradontideCor,zdidaled Mary(.@R=ip,gm�.iw)Tems A¢wnm tlue on ew/0th oltln rnoruh fosav4 mala w' ., armwhawe be d-gde FINANCECHPRGE.—PER1ODICRATEaf 1.112%PermonW,which a the ANNUAL PERCENTAGE RATEO 18%. f.1/
<br /> s rlwgeda FINANCE CHARGE at ttro PERIODIC RATE
<br /> Of
<br /> I.l2X per rriorh84 Lydd,mtle ANNUAL PERCENTAGE RATE of 18%, Pmid9 Total {O�
<br /> t I ey signi g l horeby-diy Dmt 1 have Trot cooed any of It.waste desrnbed above wkh any other hazard—waste,the Ictal hascl content is LESS Ihan 1.000 ppm,and the
<br /> k• waste does not contain any PCB's.I have complied with the requirements of the applicable California used o0 management regulation to determine this is true.i agree to
<br /> hereby c y that 1 have riot mixed any d the waste described above Wthany other hazardous—to.the total halide content Is LESS than 1.000 ppm,and the accept the additional Barges for the disposal of the waste n the information I have provided about this waste a incorrect.
<br /> lot contain any PCB's.i have complied with the requbements of the applicable C 'ema used dl nanaga°ent regulation to determine thle Is fife.1 agree b
<br /> ldnlonal dlargos for the disposal of the waste H waste
<br /> the Information I have provided about this is Incortea Generate.Carufiwtion:By signing I Certify 0.4 if 1 am a targe quantity gone tor,I certify that I have program in platy to reduce the volume and adcity of waste
<br /> CarNwu'w:8y signing 1 ceNN that n 1 am a gereraled to the degree 1 have determined a be econorok fly affordable and Bat I have miacted the practicable method of treadmonL storage,or disposal currently
<br /> targe quantly gareator,1 condY that 1 he9 program in Pace to reduce the volume and tmddry of waste available to me wtdch ndnim¢es the present and future tueat to human life and the environment Or,i/I am a small quantity generator.I have made a Good Faith effort to
<br /> Iredg..
<br /> d artu•'rtlt hizaveas t urotl to oe amnomlwiy a0adabie and that 1 have 101.1d Iha practicable meted of treatment,storage,or disposal currently i minirtdze my waste 9aneatlon and sabot ma wase marag°menta method that is available to me llat I can afford.
<br /> present ars(earn threat to human ins and the OnWavailable
<br /> In—t Or,n 1 em a small quantity geneabr,i have made a Good Faint effort a George W.Lowry.Inc,herebyadvicas the above Gonmator that generators shipment of Used W and OIIyAWater may ba transported to a facility that is required a cont
<br /> waste ganeretlon and select the wash I Ph,
<br /> VMY. management that
<br /> method that is amenable Used
<br /> that 1 iony/Wat. with federal regulations applicable to management of Used 00 and Oiy/Water,but that is not required to comply with the moa stringent requirements applicable m
<br /> regu'Inc hereby advises the above Gerreator that 9ewaars shipment of Used 00 and Oily/Water may be transported b°facility met is required b compN i hazardous waste manegumem facilities.California faced.that handle ter process Used On and Olty/Water are required W meet those more stringent requirements.and
<br /> sed Oil and ase regemem lb-1111—California°afadittes that handleOI�Nvaar,but that ls not required to comply with Dhe more strkgerrt requirements applicable a sem.out-of-.Yate fadndee,mat process Used 00 and Oly/Waar also meet those requirements,engineering certfi®tion,of tank integrity.and financial assurances for
<br /> Used 09 and OflyfiNcier—required to mce,u_
<br /> soma aaTities that pmeara Used Ota and 08y/Weter also meet those requIne mens.,anginowing oardreder c or tank mea shingont requuemmts,and dosum and accidental releases,n Is lawful to send Used Oil and Oiy/WaU r a out of state faWtles that comply only Wth federal Used 00 and Oly/Water management
<br /> m9agrny,and 0nandal a.suances fur standards and not these moa stringent requirements.
<br /> d"`d hal-leases,tis awful to send Used Oil and Oity/Water a out of sate led6tes that Comply only with federal Used 00 and O /Water mane
<br /> d net these more stringent requirements. 0Y gement T}ds notification ls for the afartatiowl puq»ses Doty.
<br /> on is for the mfomzaderal nty. By both partes signing this Invoice n 981 n gremnem that George W.Lowry,Inc will submit oonfimallon for(eertam waste streams)a the gene-tor that their
<br /> waste has beernt mesported to a pertnitletl r ury or per rated tmatment,storeg.or da II
<br /> 1s signirg thls invdco n wit s s a greemem that George W.Lowry.me,caul submit confirmation for(certain waste streams to the pos/�
<br /> enter sported to a perm tra a duty or erm'tied treatment,swage or disposal facility. ) generator that their - Lowry Driver Signature X Dafe—l
<br /> river SignatureX Date L
<br /> f
<br /> Signature-of Generator,Represen five or Agent of Generator. X
<br /> 1aof Generator,Rep nfative or Agent of Generator. X � Data —Z!'t
<br /> ----)Recycling,Transfer,Treatment,Storage,Disposal Facilities N„m:
<br /> 'cling,Transfer,TreatMent,Storage,Disposal Facilitie ❑ �jl ❑
<br /> Name: d1 Adds-s:
<br /> �tJU1� ❑ Addraaa: Bakersfield Transfcr California Il Reryding Ramos Envkonmurai Yuma Environmental City,Stam,zip:
<br /> r 1620 E Brundage Lan.5300 Claus Road 1515 S.River Rwd 2730 E 13th Pnotw:
<br /> .far Ca tom 011 Recycling Ramos Environmental Yuma Environmental City,scam,lip: Bakershid.CA 93307 Riverbank,CA 96367 Wmt Sacarecur CA 95691 Yuma,AZ,85365
<br /> 1. 5300 Claw Read 1515 S.Rhmm Roatl 2730 E 13th 661-=-8258 209.86"86( 916371-5747 928-344-9826
<br /> 93307 219461-14 I 96367 Wast Sacramento CA 95691 Yuma,A2;85365 Prom: CAL80°28258 CALOOD019081� CAD004003556 A7R000515924
<br /> 20986381916371S7q 928-344-9a26
<br /> CAIe0u0190817 CAD004003556 AZROOOSIS924 EPA ID:
<br />
|