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rte lvm <br />Forth Amovad. OMB No, 2050.0039 <br />CrM roar) o/Vl►CL (mev. 1&I f; rravlDUS 9UMOnS are oosaleae. DESIGNATED FACILITY TO EPA's e -MANIFEST SYSTEM <br />. UNIF - 'NAZARQOlJS <br />? IC Number <br />2. Page ? of <br />3. Finargeney Response Phone <br />022071448 JJ <br />CALa0042s <br />1 <br />�- <br />5. G lal rdore No* and Me1" OWM Qnffetors Sib Address (11 d Mnm Mel" &HIM) <br />C6y �T►scY C�y of Tracy John Janes Water Trest[ttent Plant <br />6649 S �Y BW 6649 S Tracy Btvd <br />Tracy CA 963n TMCY CA 9637-' <br />ce,�rator: Phare: <br />6. A elsol r 1 tattprry Nerve U.S_ EPA ID N+mlber <br />Environmental Logisfts, Inc. ICAR0002 1 7 5 1 3 <br />7. Transperter 2 Con pmy Name U.S. EPA ID Xwnber <br />& Desgnedad Facility Narne and SbAddrm US E?AID slumber <br />i" annot hic- <br />6:300 mum Dr <br />Karam Cay MO 64129 <br />F s 1 1 2 9 <br />93. <br />9h U.S. DOT Desc fpfm <,irxAtdfng Proper Sh'pmig Name. huarl Class. U Msnber, <br />n9 �uP til any); <br />la CorrtaVers <br />!1. TOW <br />12 UM <br />13 WasteadPs <br />No. <br />Type <br />HM <br />Duan* <br />WLNd. <br />go <br />�i <br />.. <br />1 <br />UJIz <br />� <br />9N+09util3Z6U, <br />GUMS 6040 0 "'d U q0talr *-racy <br />Z .79 <br />X <br />'UM1. Vr9AtSTE Potftkrrn oerlrtantnate, S_Z PCM <br />I <br />I bWa .331 <br />4.041 (z b3 t0hf7 t ?*/0 ZEI,ftM A-147& 14C <br />14. special 0lowm-tg karde iorK� Addl" 11* mom <br />Imam me EIRW <br />OW <br />eVOO ,SIO <br />A yr .,nia /t#tn6ft utt I/z- <br />15. GENERATORVOFFEROR'S CEMICATION: i hereby declare M the contents of oris ooaelgrment are fully and amralefY desatbed above by the proper shoping name, and are classified. adage', <br />marked and labeledlolacarded, and are m all respects in propw wdirar for-ransport awarding to applicable mierrahmal and nationat gevernmantat neguisdons. N expos shipment and I am the Primary <br />Exporter, , canify Jud the contwft of ft consignmend conform to the gems of, he aflached EPA Acknowledgment of Cament <br />I certify tat the waste minimization sfatemeM Went Pied in 40 CFR 262.27(a) of i ern a large 0uarrtily ger,"Orl or ;b} (if I am a 61! eratat 15 acre. <br />f7 ��-.�r,1�,.�� S zo z( <br />J? <br />. ir?ternalona . t <br />import U 5 J E port from u S. Port of entryleAt <br />Trar,%ot <br />r signahlre (fcr exports only): Date leaving U S., <br />W <br />17. TransporterAdmow;edgmsnt of Rem of Matenata <br />rC <br />Ti�rraporser t )leave Marth Day Year <br />' 76 ZI <br />11wWww 2 Pdntedlr m" mm* Day year <br />t- <br />1&_ 7lscepenc7 <br />1ga' D(s ` NdcOmSpwo Elouardlty ❑Type ❑Re_wdue ❑I.Mat Rejedian FlR.edla <br />WAWW Reretence NW,tm <br />I&MerrudeFacft(orGerrerwwi U. S. EPA IONunbe• <br />tea <br />Fs4� Phone: <br />Lu <br />180. Signature of ARemete Pecfrty :lar -MW Month 'Day Year <br />19, Maza•daus Was% Rapet Mmagement Method Codes (.e- codes for haaardms and wwkrg syvems; <br />s. <br />hie Y Name slgr?atwe MWO Lay Year <br />CrM roar) o/Vl►CL (mev. 1&I f; rravlDUS 9UMOnS are oosaleae. DESIGNATED FACILITY TO EPA's e -MANIFEST SYSTEM <br />