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Viral_. SIS, SHIP# 22875/893 <br /> dQb4b04896KS <br /> �4:ase print cr type- Form Approved.( No.=4)039 <br /> 1 UNIFORM HAZARDOUS t•G—w to Number CAL0100117545 2 Pagep I E�pplAgr R�spo�te PJ%0 4.Manifest rac Ing NEmew <br /> WASTE MANIFEST 1 t}►7Y3 btl 1/b 1006960489 SKS <br /> (4 5.Generators Name and MaL%V Address Generators SkeAdd=('d Efferent Than mating address) <br /> Chase Chevrolet <br /> 6441 Hdlean Rd <br /> STOCKTUN CA 95212--2703 <br /> GenoraZes Phone: 20.9-475-6630 <br /> 8.rr�rS�y tAaros SYSTEMS INC U.S.EPA ID Member TXR000081205 <br /> 7 Transpaler 12 tom GNatm�el U.S.EPA ID Number Cl.EAM H 7B'S1S ENVIRONMENTAL SVC INC. MADO39322250 <br /> e.a gnaledFarwyNameandSiteAddress GLEAN 14ARBORS (IF WILMINGT©N U.S.EPA ID Number <br /> 1737 EAST DENNI STREET <br /> WILMIIVGTDN , CA 9(D744 <br /> CADO44429835 <br /> 310-835-9999 <br /> I'aClJly'6 Plrana. <br /> ga. 9b.U S.DOT D9srafpti=Cwdod rg Proper Srppng Name,ftazasd Ctw.ID Number, 10.Contain9�124. <br /> Ii TOW 12.Unit <br /> N,N and Peaft C-w(d any1) t3.Waste Cedes <br /> No. Ouarltity 14T-fUof- <br /> X 1 NA3077 HAZARDDUS WASTE SOLID, N.G.S. P DO0 DOOM181 <br /> (CHRbmiuM, LEAD), 9, b6 III C36 <br /> r <br /> 2. <br /> A. <br /> 14 saaaal Handstrg tnstrucbons andAadrtloaal bdarrna8an TSD:W I 80218127 CH40400 `CSG: <br /> CL 1}14 EME71- [.7� -L� <br /> 24H #<MER hiCY E301b-468-170,0—CH/SK/TFT--Contract r etaine�E by genera dr anfer$ a enJyv authori y <br /> DTI initial transporter t1] add or substitute additional transporters on enlrra�Or's behalf. <br /> 15. GENERATOKNOFFEROR'S CERTIFICATION:f hareby declare that the mntards of Ihts consgrnmeaf are Uy end atcuratefy described above by the proper dlppitrg name,and are dassw,padw*. <br /> marked and laberedfpiacarded.ww are in aft respects in proper cor dibon for banspat accor6rtg to appkabfe imternati"and nab"govemmentat regida W.M export sh0wrd and I am the Primary <br /> Exporter,t rjlr*that use cakelrrsd Oris mrs grunant corftm to the terms of the adadW EPAAtkrmiedgmerd of Consent. <br /> I certify I."the wash minrnfzasm statement idenb8ed in 40 CFR 282.27(a)(if I am a targe quantity generator)or(b)(it I am a small quantity generator)is ma. <br /> Geteratorsl s PdrdedRy*Narm SiGna4rre , M00 Day Year <br /> 7" �Tl' tf 7 N 7�N u <br /> _a 16 Irrtemabona.'Stupments <br /> F- ❑Import to U.S. ❑Eaport from U sort of er"Ient <br /> 2 TransWol sig uturn(for expods v N): Dale leavrng U s. — <br /> o: 17 TranspoderAtlnpwmemf Rf M <br /> WjoecetA oaterials <br /> z ~ <br /> 0.1r r 1 Point V' Name S' Month Day Year <br /> V. ,,,u - t� ! <br /> °ai <br /> 7 <br /> a 2 Psi ypetl Name Slpnatwe Month Day Year <br /> ~ <br /> 1B.{liscrepark7r <br /> 18a Dsrrapamxy Indrealw space ❑ouawy []Type ❑Residue ❑Partial Rejection ❑Full R*cd m <br /> } <br /> C 18h.AlMme6a Fairy(pr GGtem;or) Mertlfsst Reference Number U.S.EPA lD Number <br /> J <br /> V <br /> w Feo41y's Pr.ne: <br /> W 18C.SignaSlreor whale pocky i or benerafar) Or Day Year <br /> cc <br /> :z r <br /> '9 tfatam:-wWaste Ma <br /> ;n Rxpert Management Method Codes(I.a.codes for hazardous waste bealmwsl,d**sa;.and recyti system) <br /> 111141 .- r <br /> 4 <br /> ;'9 Dssrgnated Fa;1¢y 0wrsr or ppe'e kx-Certitabon a1 receipt o1 hezarft3 matanals covered by the marifist except as nrted n Item I8a <br /> i'ry sedfr}ped Name Sgnature Mow Day Year <br /> JDY <br /> E'�t I' za171eYialss editions are obsole . DESIGNATE0 FACILITY TO EPA's e-MANIFEST SYSTEM <br /> 0I <br />