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Please prim of type. Forth .OMB No,20500039 <br /> Ut11FORM HAZARDOUS 1.Ge 101 ID Number 2.Page 1 ei 3.Emergency Response Phone 4 Yallffast Tneldny Number <br /> ,HASTE MANIFEST CAc0D299860, 909-620-a69J 019586916 JJK <br /> 5.Genr=es Nene and MAN Address Generators Site Address(d d"ni draft mailing address) <br /> . FetlF.x Ffetgtri 1000E Roth , <br /> ��oARR�15 French Camp,CA 56231 <br /> W) GeraraltabPhone: S014MIMU <br /> ' 8.T..MPM 1 Cary"M Nana U.S.EPA ID Number <br /> C HEC,inc CARM77699 <br /> 7.TmWm w 2 Coopm Name U.S.EPA ID Number <br /> m N=Mdal Waste tAlllzatlon,Inca <br /> ( 1: i 0dgrra Fancy Nana and SM Address U.S.EPAID Number <br /> 1 t AA SYOCOL,LLC AZKM52M <br /> 2261 F—13M St <br /> Yuma,AZ 86365 <br /> F Pl+orrc928-7&3w 1766 <br /> _ fk 9tL U.S DOT Daacpeon&Judirg Proper ShlPPkV Nary,Hwad Class,ID Pbarber, 10.Containers 11.Tow 12.Unit 13.Waste Codes <br /> HM and Padirg Group(I air)) No. Type Quantity WLNo1- <br /> Y 1. <br /> oNon RCRA Hazardous Waite Sokd(Absonwit w/Cnaln Lube CID r DM P dQ <br /> LU Non-RCRA Mazardour:Waste Solid(Cleating Rags Oebo6 wf Cnain oil) ! ON P <br /> d Non-RCRA naZalfdeUS Waite Solid(Cardboard Stained Boxes w1 CIO ( DM P 392 <br /> 91 <br /> • 14.Swcr 1111010 n and Ad3eonal Information <br /> 90(1) <br /> 1114, 9b(2) 1 X55DM 9b(3) 1 x550M <br /> 15. t;EERAT0Wa10FFFR07C3 CFRMICATION:I hereby declare that the contents of Ws consignment are My and awxately described above by rhe proper shipping name,and am classified,packaged, <br /> markW ad bbebd'plac rded,and ane In all respects In proper codition for transporl according to eppkable inlemallonaland national governmental regulations.If export sMp lit and 1 an the Primary <br /> Exporter,I o*hat the oaawrb or Ns conWmem mdorm to the term of die attached EPAAdoauledgment of CmsenL <br /> t i orgy to Mr wash rtirininCon slatemerd Identified in 40 CFR 262.27(x)(d I am a large quandry generator)or(b)(81 an a sma11 quantity generator)is true. <br /> Gww, WIPWI;PratledRypedName 0' 415—K Sig Month Day Year <br /> 64,P141 <br /> 1 <br /> Q t6.krtwruntlaral S1s{snerrb ❑Import to U.S. ❑Export tern U.S. Pat d entrylex t <br /> WI ? Trarrspabr;0*A"Ua ev"onyx: Date WYN U.S.: <br /> 1 •�� X 17.T AdxpwlwignotdReceiptofMalsrials <br /> Trans ypedNwe� Sgn MQn� Day Year I <br /> / <br /> a a L <br /> ' a <br /> • a T 2 ftftVyped Nam Spnafure Mmth Day Year <br /> 18.Discrepancy <br /> 18a Discrepancy tdio6on space ❑Cue lily ❑Type ❑Residua ❑Patfal Rejection ❑Fur Rejection <br /> •IMI . <br /> ). 18b.Alremata Fxdq(a Generale) Maritest Reference Number <br /> U,S.FPA O Number <br /> U <br /> Q <br /> LL FadRys Phare: <br /> QF 18C.Sgr"n of Alternate Fack(a Gwrerator) py Y <br /> z <br /> y19.H�tlow Waste Report Mxnagemeni Method Codes(i.e.,cafes for hamrdous waste beaenent,disposal,and recycling systertn) <br /> 0 1 2. 3. 4. <br /> n <br /> 20.Designated FaciFty Owns or OW tr.o rcfam d receipt of hamrdars r'WWs covered by the manllest except a rk0ed In Item 18a <br /> $ • Pr rdad/Typed Nate <br /> 1 ` , gnature Ih . <br /> EPAForm e70o 22(tey,12.17)previous editions are obsae(e. DESIGNATED FACILITY TO EPA's 04WIFEST SYSTEA <br /> Scanned with CamScanner <br />