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Please ;.int or 45m (Form deslcned for use on elite 112•aitchl twewrltec) <br />FnrmAmmwrd r WP rJn McAM90 <br />tt'ArOfmSrUU-11(ReV.Mb) Tamm me(IMMslireobelllefe. DESIGNATED FACILITY TO GENERATOR <br />1 Generator IDN <br />2. P 1 <br />- - ---- ---- <br />WASTE MANIFEST <br />.,000329569 <br />1 <br />916--371-5747 <br />016781159 <br />JJ K <br />5 Generators Name and Malting Address GerwWs SleAM= (K d8fererrl than maitarg address) <br />Bird Road Yard & Shop Facility <br />23623 S. Bird Rd,Tracy, CA 95304 <br />Geeerators Phone 514-715-8466 <br />fi Transporter 1 C nepany Name U.S. EPA 10 Number <br />-0 WASTE O CAI., 913 534 <br />912 <br />7. Trarraporter 2 Company Name U.S. EPA ID Nmft <br />�Y" _ gec veru Systems -.& 000 175 <br />422 <br />8. Designated Faatty Name and SJR Address U.S EPA IO Number <br />Yuma Environcental Services, Inc. <br />2730 East 13th Street Yuma Arizona 86365 <br />Fadit,'s Phone. t1 c , r..,., k r A�.: "7 515 <br />924 <br />9a <br />9b U.S. DOT Dear *ism irdLidrg Proper Shipping Name Hazard (lass, W Number, <br />10Cmtainera <br />11 Total <br />12 UM <br />13. Waste Codes <br />No <br />Type <br />HM <br />and �n9 Group (d any) a <br />Quar bty <br />WuAb1 <br />t <br />NUN-RGRA HAZARDOUS WASTE SOLIDS <br />OILY SOLIDS <br />1)M <br />Z <br />2 <br />w <br />Li <br />3 <br />" <br />JUL a 5 201 <br />- <br />- - <br />4S. [ -'-J"-1 t <br />EQUIPMENT DI 10 <br />1A. �9 4utruclions and Adottlona! Inforrrtation <br />"DLERS TO BE TRAINED AND USE PPE <br />15 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedare that the contents of this oorrsigrment are hotly and accurately described above by the proper shlpping name, ard are classified, packaged <br />marked and labefedoaiarded, and ere in ail respects in proper condition for transport according to applicable intemationaf and national governmental regulaborm If export shoTwit and I am the Primary <br />Exporter, l certify that the contents of this consignment conform to the teens of the attached EPAAdawwledgment of Consent <br />I cartfy that the waste minhr$abon statement identified in 40 CFR 26227(a) (K I am a large quantiy, generator) or (b) (KI am a wW quantity generator) b true <br />Generatoes101feror's Prinledlfyped Name Signature <br />Month <br />Day Year <br />( ,Jo v o �--�- <br />1 G l <br />s mtelr ationa Shlpmerus ❑ Import e u s ❑ Export from U.S. Port of entryreA- <br />-- <br />Transporter Knature (for exports only): Data Ieavir g U S: <br />17 Transporter Admowledgment of Receipt of Matenats <br />Transporter 1 PiotzyTyped Name SignatieD <br />y Year <br />. - •..2 <br />Q <br />Tri Frntedrryped Name <br />Yaw <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ OWntiy ❑ Type ❑ Residue ❑ Partici Re}er bon <br />❑ Full R"cb. <br />Manifest Reference Number <br />18b Aftemate Facility (or Generator) U.S EPA 10 Number <br />U <br />ra+. <br />Facility's Phone: <br />18c SlgnaWre of Ahemate Faatlty ;or Generator) <br />Month <br />Day Year <br />Q <br />Z <br />N19 <br />Hazardous Waste Report Manapnenl Method Codes (I.e codes for hatwxbA waste treatment disposa and recycling systems) <br />O <br />1 <br />2. <br />3 <br />4 <br />20. Designated Facility OwW or Operator Certifrmtian of receipt of hazardous matedais covered by the manffest except as noted in Item 1 Ba <br />Fr.vi i Typed Name r^aturaMw& <br />Day Year <br />d <br />1317 <br />1111 <br />tt'ArOfmSrUU-11(ReV.Mb) Tamm me(IMMslireobelllefe. DESIGNATED FACILITY TO GENERATOR <br />