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Please print or tune. (Form desioned for use 6h elite 112-nitrhl tvnavaiiterl:rec; <br />Fnrm Annrnvad_ OMA No. 2115fn-(1n9A <br />I:PA Form BIUU-z2 (Hev. •s-05) Previous eattions are ousorete. ) DESI HATED FACT ITY' 'O GENERATOR STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS 1. Gorrera. . Number 1, t 7r P5 aj oT <br />CAC 2 3 4 8 9 I11L <br />3 Emer an Res nse Phone <br />��� 4-9�' <br />4. Manliest 7racktn9 Number <br />01 0 5 9 JJK <br />WASTE MANIFEST i s.. <br />«eae r.� <br />5. GeneraWr s:;::_ .,- j Generators Site Address (if different than mailing address) <br />6'4.1 >vUE4it�TN ttgir< <br />123 W SONORA STREET <br />STOCKTON CA' 195203 <br />209 009704 1 ? ' <br />Generator's Phone: r <br />s. Transpor RRIA�r �ONM AL SERVICES ; � U.S. EPA1. �tV�'ber2 8277036 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8. Design ijyltaLn�and$ d !Y U.S. EPA ID Number <br />t220��0 <br />riid��.NNALAlyi3iffEDA STREET <br />COMPTON CA 0,02:22 ' CAT080013352 <br />Facility's Phone: (320)537-7100 - <br />9a. <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, 10 Number, <br />'lo. Containers <br />11. Tolal <br />12, Unit <br />13. Waste Codes <br />No, <br />Type <br />HM <br />and Packing Group (dany)) <br />Quantity <br />WUvol. <br />77%W,UI ,FU. ( 1 <br />DW1 <br />DO1 <br />343 <br />o. <br />►— <br />WJ, <br />" \ <br />OILp, Pq II <br />zr <br />2. <br />u.n <br />3. <br />4, r . <br />14. Special Handling Instructions and Additional Information <br />BAERGENCY CONTACT : CNEWREC 1-800-424-9-300 PROFILE 0 OFILE 0 962: AP203469 METAL GRINDINGS, 9BI : <br />033116-1 GASOLINE, DIESEL, OIL * *APPROPRIATE PERSONAL PROTECTI EQUIPMENT <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and labeled/placarded, and are in all respects In proper condition for transport according to applicable International and national governmental regulatlons. If export shipment and I am the Primary <br />Exporter, I cedify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br />I certify that the waste minimization statement Identified in 40 CFR 262,27(a) (If I am a large quardity generator) or (b) of I am a small quantity generator) Is true. <br />Generatoes/Offeror's Printedflyped Name Signature Month Day Year <br />t— <br />16. International Shipments Y <br />❑ Import to U.S. El Export from U.S. Pot of entrylexib <br />Transporter signature (for exports only): Dale leaving U.S.: <br />w <br />17, Transporter AcknowfedgmentofReceiptofMaterials <br />Trans r 1 Prjntad/iypg ame / Signature. r Month DayYear <br />a. <br />z <br />Transporter2 Printedfryped Name 'Signature Month Day Year <br />sx <br />18. Discrepancy <br />18a. Discrepancy indication Space ❑ Quantity ❑ Type❑ Partial Rejection T ❑ Full Rejection <br />RE&WEDManifest <br />Reference Number. <br />18b. Alternate Facility (or Generator)rn • U.S. EPA ID Number <br />fr <br />. 6{'° <br />U <br />u- <br />Facl iiy+s Phone. r <br />w <br />18c.SignatureofAlternateFadiity(orGenarator) Month Day Year <br />PER PSER <br />s— <br />4 <br />s CFe <br />Z <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment disposal, and recycling syslenes) <br />1. rpt1 <br />✓ <br />2. <br />, <br />3. <br />09 <br />4. <br />20. esignated )'adlity Owner or Operator. Certification of receipt ardous materials covered by the manifest except as no,ad kn Item t6a <br />,' <br />Pnyped Nartig � Signature a Ih � � r" <br />r <br />I:PA Form BIUU-z2 (Hev. •s-05) Previous eattions are ousorete. ) DESI HATED FACT ITY' 'O GENERATOR STATE (IF REQUIRED) <br />