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y <br /> Please pririt or type.(Form designed for use on elite 12-pitch typewrite{.) Form Approved.Oh16 No.2050-0039 <br /> UNIFORM HAZARDOUS 1•Qeneratm V Number 2.Pegs 1 of 3.Emergency Aes Wse Phone 4. ani est Trac umbo. <br /> W , TE MAHIFE! ,C A L 0 U 0 4 3 2 91 4 1 (800)424-9300 018529411 JJ K <br /> 5.Gen ralor's Nara and Mawrj Atdress Generalors Sita Mdress(if different Oran mailtng address) <br /> J FFY LUBE#3808 <br /> 276 GRANT LINE. RD <br /> 3 RACY CIS J5301+ <br /> Generi tar's Phone' 209 229.7918 <br /> 6.Trvr porw t Company Name U.5.EPA kO Number <br /> NVORLLI OIL ENVIRONMENTAL SERVICES CA 1]❑2 82 'r 7 036 <br /> 7.Tra• ar mpony Name U' -EPA ID r <br /> VORLI]WIDE.RECOVERY SYS1 EM II`iC. j CAR 0()0 1 7A,42? <br /> 8.Des naiad Facility Name and Ste Aduress U-S,EPA 10 Numtxer <br /> ( VIA YEv Llk,' <br /> 130 E 13 '-'I <br /> Faol6l s Phone' 6928):1411-96''B <br /> ga. 9b.U.S.DOT Descrip ion Iiadud q Proper Shipping Name,Hazard Class,ID Number, 10Conte hers 1t.Twat 12.UrA 13.Waste Codes <br /> KM and Packing Group(J any)) No. Type Q4anGty VVI-[Vd <br /> INCIN-RCRA HAZARDOU!WASTE,501.117[OILY SOLID.PAPER FiL!Lil:5) � r2 <br /> Q <br /> Z 2 <br /> i <br /> 4 <br /> t <br /> 14.Special IiatWiq Instructions and Addilks,4 mformalior+ <br /> I- FPG'NCY 00NTACT.GI-IMIT R+..0 1.--8CK)-424-t 0C-WO FS TI-RMINAL' " NliO ILL#901 . 16`2623a`'lR8 761 OILY S0L1D. L••r <br /> P PER PILTERS " APPROPRIATE PPE 1:QUIPIVIE14f cy X <br /> 15. GONERATORVC)"EROW5 CERTIFICATION: I hereby declare That Ne contamS of this ootis+gnntenl are fusty and aocufately descnoedd�aW"a-y Me proper snipwng name,and are classified,packagetl. <br /> rrpAed and Iabeledlpkacarded,and are in all respects in prover condition for vanspcn according to appficBwe Intemabonal and national governmenlel regulations.If expo.,ahvpmena and I am the Primary <br /> Ekponer,i cenify thea the contents of this consignmentconform to the terms d the ahached EPA Ackrnovoodgment of Consent. <br /> I erfify that she waste mifllmiza4on statement identified in 40 CFR 282.27(a)(it I am a targe quantity generator)ar[b](if T ant a small quantity generatoq is true. <br /> •e toe 1011erres P . yped Name 91 re <br /> Month Day <br /> Year <br /> �vr 19 j 14-ef #V elm <br /> J 16-1 ralmak4 Shlpmem <br /> ❑Import to U S. G we from U.S. Poe of entryAxit: T _ <br /> Transtwrtar argnatuee(tor exports only)' Date leaving U.5.; <br /> � 57.7 sanrterAoitnawiadgment oI Rece,pl of AtatersaEs <br /> franspon P nte�yNdme Sgnalureac <br /> Month Day Year <br /> a 3 <br /> CA S star Month Day Year <br /> 4 TranapDner 2 Prme yped am <br /> k L r <br /> IGI <br /> 18.Dxs�rep"y ;II <br /> 18a.D ore •ndi[ation Space E Quantity LJ Type I_J Rfesio-us Parra o ecliui. LJ Ftdl Rajectidn <br /> Mardfeb-t Reference Num4er. <br /> Ilib. rnate Faddy(or Genafatar) U.S.EPA 10 NLmbv <br /> J I <br /> V <br /> Tai Faclhtyt Prione: <br /> 18c.S�Vure of Aiternate Faciity(or Genwator) V. Nh Ca; Yea <br /> a ) f <br /> Ht9.Hazardous Waste Report Manage Mont Method Codes(i.e.,cocas for hazardous waste treatment,dispoear,and recycli:xD systemsy <br /> t 2 3. 4, <br /> 1t-� <br /> 20.De;ignalad Facsity Owner or Operator:Certka(ion of receipt of hazardous materials covered by the ma qoe t euce nded,ri Item 1 Aa <br /> �n yped nature _� h ay Year <br /> Ly <br /> EPA Form 8760.2 (Rev.3.65) Previous editions areobsole!e. rACii -n,v,- )1)F sl'I1VA"I'ION 9T'ATe 0 tQIlIlF�ft <br /> I <br />