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Tease print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2,Page 1 of 3.Eme genoy Response se Phone � 021324503 .Manifest Traeking Number WASTE MANIFEST C !�, C� D 8 ;2 0 3 0 2 0 7 1 83+88 187 a 72G. JJ K 5.G Aerator's are.�nd ails g Address tt: nvironrnerr anragetYlef it Go orator' iteA dre (if elfferent than mailing address) fir,non�elClt'Ir:: �Il�rnad L nlnn aol i0 i�ailroad 400 Douola-;Street-Stop 10317 333 E Irt#7 Street Omaha NE 1581701 Stookton CA 95206 Generator's Phone, 1.1 1 0 J 4 P -• 0 4 a 5 6.Transporter 1 Company Name _ U.S.EPAID Number American intenrated Se»'iees, Inc. ru A lam' D 0 17 1 4 8 3 3 3 7.Transporter 2 Company Name U.3 EPA 10 Number 8.DegIgi ate�d FaVlityName and Sto Address U.S.EPA ID Number C rGSGiy 4Jvettr_�n,inc. 1620 VV i 7tH Street Long beach tw A 017313 Facility's Phone: 5152 432-5445i'~, A D 0 2 8 4 Q r9 0 1 19 ............._._. 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit and Packing Group if an Quantic WLIVOL 13.Waste Codes HM 9 P(� Y)) No, Type Y 1. Non-RCRA Hazardous V'bste,Liquid(Transformer Mineral tail) 221 0 Z 2. Non-RCCA Hazardous Vh5te,Liquid(Ttansforrr,er Mineral Oil and 223 LU A D.M G 3_ Non-RC RA Hazardous Write,Solid(Oily Debris) 35 DM 4. 14.Special Handling Instructions and Additional Information A.l-�,sajr5 Wear_ Appropriate PPI~ when handling 14azt-e- WeightZ or volume ar:e Approximate. 9b_1) 11'3041 9b.2) 11'4042 9b_-2)114042 .A.TS Jab Number:790:3-101 T4P.#20838 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,aid are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemalionaland national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified In 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator's/Offerors Printed/Typed Nam Signature Month, y Y 16.International Shipments i— El import to U.S. Export Goin U.S. Port of entrylexit: _. ...... ..... Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year tl Tra p ter 2 Printed/Typed Name net Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ quantity ❑Type ❑Residue j Partial Re ection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number V ti Facility's Phone: W 18c.Signature ofAiterate,Facility(or Generator) Month Day Year d 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed.Name Signature Month Day Year 1 L EPA Form 8700 ev. 2-17) Previous editions are obsole D ED FACILITY TO EPA's e-MANIFEST 01STEM