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Please afint of tvae. (Form daslaned for'c A 9-nitrhl hmAwrilpr.) .11113 MA WrA 11n7o <br />r-r-Arurmofuu-«tmuv. a-vot--grevouseumons areoascuste. DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) <br />UNIFORM HAZARa0US 1, Generator ID Number <br />2. Page 1013, <br />Emergency Response Phone 4. Manifest Tracking Number <br />WASTE MANIFEST " A Ei (t 2 4 4 4 x 0 11 4 <br />1 <br />Circ) 42443013 008139601 JJ K <br />6. Gonerator's Name and Mailing Address Generators Site Address (if different than mailing address) <br />SI1r15- 1•i1.00 NEU _ STOO T (3N <br />1LW, J S. AUROM ST ICOO S. AURORA ST <br />STOCKTON CA MW STOCKTON CA 952011) <br />Generafoes Phone: 2w gad <br />6. Transporter 1 Company Name U.S. EPAID Number <br />ASBUR`( EWRONNENTAL SERVICES C A D Q 2 B 2 3 7 0 13 6 <br />T. Transporter 2 Company Name U.S. EPA ID Number <br />8. Designated Facdity Name and Site Address U.S. EPA tD Number <br />DENY NNO I KFrZOO N <br />2000 NORTI-I ALANEDA STREET <br />COWTON CA 902222 <br />FacilivsPhone: (310)637-7iOD C A T 0 0 0 4 1 3 3 5 2 <br />ga, <br />9b. U.S. DOT Description (Induding Proper Shipping Name, Hazard Class. H) Number, <br />10. Conlainers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Pad* Group (d any)) <br />Quantity <br />WtNel. <br />o <br />1. <br />t"JO # Ri�RA f W7�C0US �'1ASTE, LIC�Uiii (I-IALOGEMAT%D OIL OVER <br />� <br />�} <br />4 ! <br />mo PFNI <br />Z <br />2. <br />Uj <br />3. <br />4. <br />14. Special Handl'ng Instructions andAddibonal Informalen <br />' PROFILE 4.9,91: 027170 ENURGENCY CONTACT: CHENITREG EC?-424411CO PROJECT 4 &=A15 ORQER #4490,50 MV <br />APPROPRIATE PERSONAL PROTECTIVE EOUIPNENT <br />15, GEN EMOR'SIOFFEROR'S CERTIFICATION: I hereby dedare that the contents of this consignment are futty and accurately described above by the proper shipping name, ani aredass Nd, packaged, <br />marked and labeledlplacefded, and are fn an respects In proper condition for transport according to applicable inlemadonal and national governmental regulations. 0 export shipment and I am the Primary <br />Exporter, I certify that Ne contents of this constgnment conform to the terms of the attached EPAAclumeedgment of Consent. <br />I certify that the waste minimization statement "identified in 40 CFR 262.27(x) (If I am a large quantity generator) or (b) (if t am a small quantily generator) is true. <br />G neratoeslOHe(ots Pdnted T- Name S nature (Aon D� Y a <br />1 <br />...1 <br />i— <br />16. fntemaWnal Shipments <br />❑ Import to U.S. ❑ F_k a from U.S. Part of entryfeAt: <br />Transporter signature {far exports only): Date teaming U.S.: <br />17. Tmnsporter Ackradedgment of Receipt of MateAels <br />raef 1 Print ed Nama Signature <br />Transporter2Pdnt NaMe Sigaatura/ Month Day Year <br />18. Discrepancy <br />�� <br />18a. Discrepancy fndicabon Space EllQuantity ❑Type ❑ ❑ RoW. Partial E <br />Rejection l Full Resection <br />Manifest Reference Number, <br />18b. Alternate Facility (or Generator) U.S. EPA 93 Number <br />ti <br />u <br />Facililys Pttorw <br />18a5gnaluraolAllemateFadlity (of Generatof) <br />Month Day Year <br />4 <br />a <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, <br />and recycling systems) <br />0 <br />1, <br />2, <br />24,Designated Facirdy Owner or Operator. Certfication of receipt of hazardous materials covered by the manifest except as noted In Item I Be <br />PrintWyped ham (� ignalare th Da Ye f <br />r-r-Arurmofuu-«tmuv. a-vot--grevouseumons areoascuste. DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) <br />