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P%a'se pdnl or titpe.(Faun designed for use on elite(12•pitch)�ypswriter.)8 x <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 7 of 3.Emergency Response Phone 4,Manifest7lackin Number <br /> WKSTE M,4.lIFEST ,. D , , ;� , r �45a-3��a 007133395 FLP <br /> ELD6RADC5A.UTG Att R� -`AREI-nUIROGA - <br /> 5.Generators and Melling Address Generators SlfeAtldresa(d dlfierenf dean mailing address) <br /> 2070 ELDORADO ST <br /> STOCKTON CA 952013 <br /> Generators Phone; a A p q Ka <br /> 6. rensporterl ompany Name <br /> U.S.EPA ID Number <br /> OF E,virQnmertai Services C A T 0 0 0 0 2 4 2 4 7 <br /> 7.T2nsporter 2 Company Name <br /> U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address <br /> DEMEN 4Os;KERDL Oto U.S.EPA ID Number <br /> 2000 NORTH ALAMEDA STREET <br /> CON,PTON C"; 90222 <br /> Facility's Phone: ..:a <br /> s n F <br /> HM ah.U.S.DOT Description(including Proper Shipping Name,HazaN Class,ID Number, 19.Containers <br /> HM and Packing Group(Reny)) 11.Total 12.Und 13.Waste Codes- <br /> No. type Quantity Wt.Nol. <br /> 0 UN 1993,V-AS r'farn nabie Ilq aids,n.Q,s. <br /> X 3,PGIII (Gasoline and V=-DE,m;Ywrel DOD! 348 <br /> z 2. 0 0 1 IT I7e6 G <br /> W <br /> C9 <br /> 3. <br /> 4 <br /> 14,Special Handling Insh icdons and Additional Information <br /> c;13ASOLINEAAAATER MIXTURE. VYEAR PROPER PPE MEN HANDLING. ERG*128 <br /> ZL® :M41 <br /> 15. GENERATOR'SIOFPEROWS CERTIFICATION; I hereby declare that the contents of this consignment are fully and aminatelydescdbed above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper cendfiion for transport according to applicable International and national governmental regulations,if export shipment and I am the Pdmsry <br /> Exporter,I cervy that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br /> I certify that the waste minimtzafion statement identified in 40 CFR 262.27(a)(if I am a large quantity generefor).'N(d F.-A--111... <br /> ty generator)is ime, <br /> Gene es em sP'n amsn <br /> ai� on ey ear <br /> .� 1fi.lntemetional Shipments — <br /> ❑Importto U.S.--_. ❑Export from U.S. rartwephisext <br /> Trans ortersignature forex ods milv) <br /> W 17.TiansporterAcknowledgment of Receipt of Materials. -- Date leavin U.S.: <br /> Tran potter 1 Pdnfad11 etl Name - igna re <br /> Won 9. tear fl <br /> Transpohis 'Pnntedfryped Name ,tom I igna n: I - 11 r� - <br /> Mon ay ear <br /> 16.Discrepancy - R <br /> I18.a.Discrepancy Indication Space <br /> ❑ Quantity, ❑Type ❑Residue � <br /> ❑Partial Rejection ❑Full Rejection <br /> 181c.Nfemate Facility(or Generator) Manifest Reference Number. k' <br /> � U.S.EPA ID Numher f <br /> - U ( <br /> Q <br /> a Facili a Phone: r <br /> W 18c.Signature o1Ntemate Faclldy tar Generator) <br /> iMonth Day Year <br /> H19.Hazardous Waste Report Management Method Codes(la.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 4. € <br /> 20.Designated Facility Owner or Operetor.Ceriificedon of receipt ofhazallous materials covered by the manifest exce noted m 111 <br /> Pdn ype am <br /> Signatu <br /> Da Year j <br /> EPA. 8200.22(Rev.3-05) Previous-eamons are obsolete. <br /> DESIGNATED FACI TO DESTINATION STATE(IF REQUIRED) <br /> ( <br />