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Aug. 1. 2012 3. IOPM::..._ ... ........No• 6287--- _P. 1 <br /> Please pdnl or type,(Form des red for use on elite I2•pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> 1.Genareiar ID Number 2 Page 1 of 3•Emergency Reeponse Phone 4.Manlraef Trackih Number <br /> UNIFORM <br /> HAZARDOUS C A r 0 0 t7 3 b 4 ) 3 3C ti" 30Q <br /> 0095 2874 JJK <br /> 5.Gerwft�?5apd i� Genersee Bila Address(ff dlfferaM than mailing addreaa) <br /> 3400 AUTO PLA�WAY <br /> TRACY CA 95304 <br /> Generalofs Phone: 209 K-6-4500 <br /> 6,Transporter 1 Company Nelne U.S.EPA ID Number <br /> ASBURY EWRONNENTAL SERVICES C A D 9 2 B 2 7 7 0 06 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8:pasl�neledFecil• Name rel Address <br /> U.S.EPA ID Number <br /> S�EoIE�� r i do ff.[NG. <br /> 5375 SOU-1 -1 RKY r-AVENUE <br /> 1_GS ANGELES CA. 4O.� 7 0 3 9 9 9, 3 <br /> FaciTiya Phone: <br /> ga 8b.U.S.DOT Description(nckr N Proper Shipping Name,Hazard Clam,ID Number, 10,Corrainars 11,Total 12.Unit 13 vViale Codes <br /> HM and Pac!vng Group(d any)) No. Type Qua lilyWL/Vol. <br /> o NON-RCPA PAAWDOUS WASTF,SOLID(OILY SQUOSIC- <br /> Ix 1 <br /> LU 2. <br /> I <br /> 3. <br /> 4- <br /> 14,Sptctal Handling Inel Ucllahs and AddlGonel Information <br /> ENERGE�dCYCUNTACT:CHEMTREC 1-800-424-M NAER00581 ; 17.1"rnOnLE#9B1 :rWi91M 01LY SSbi.IDS'Pte: <br /> A11016W* `APWROPRiATE PERSO!' AL PROTECTIVE EQUjPNtNT / <br /> 15. GEN EItATOR'S/OFFEROR'S CERTIFICATIONS I hereby declare that Ure COntEVAE o1 11`�I3 consomenl are fuly and aocuralely described above by the proper shipping name,w are clumfied,packaged, <br /> marked and labeled/placarded,and are in all respecls In proper condition for uansporl accordng to appllcabie Inte4doneland national govemmenta regulations.N export shlpmenl and l em the primary <br /> Exporter,IcerVfythatfheconlantaofIh1s mnsignmen(conform tcthetermsofdreaftachedEPAAckn,W,dg,, COn6enL <br /> (III am a small quarrdly gen a is true <br /> GenerdtOr SlOffergfe PIdIped Name a Monde Day Year <br /> TA <br /> �f <br /> 16.Intemebonel ShpmentsQ 1"W to U S, ❑Er(porf horn U.S. Port of a !exit <br /> Transporter eignature(for exports only), Date leavi U.5 <br /> 17.Trenaporter Acknowledgment of Remo of Malerlals <br /> Transpori1PrIntedfTy Name SgftaUxe f} Month Day Year <br /> er <br /> o cr�uI L1 -If I If <br /> Transporter 2 Pd rthd(Typed Name Signature Month Day Year <br /> F- <br /> 1 B,Discrepancy <br /> 185.Dlserepancy Indication Space E QuanUb []Type Q Residue Q Partial Rejector ❑Full Rejection <br /> Manlfesl Re%renw Number. <br /> 1 Bb.Allemale FacMlty(or Generator) U.S.EPA ID Number <br /> U <br /> LL FaoNys Phont: <br /> W 18c.Signafurs of Altemate Facility(or Generator) Month Day Year <br /> Q1 B.Hazardous Waste Report Managemerrf Method Codes(Ire.,codes fol hazardous Waste Ueabnent,dlsposal,and recyding eyetams) <br /> 4. <br /> 20.09&gnaled Fack Ow t or Oper o.Cerdficadon of receipt of hazardous maleAal3 covered by rhe marrfesl except aa.ndad in Ilam lef <br /> Prinledrryped amsnalura Mon Day ear <br /> ri 01AAA 24Ad <br /> EPA ron IiTOT227av 3.0 ) Previous editions are obsolete. DESIGNATED FACILITY 70 DESTINATION STATE(IF REOUIRED) <br />