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Vb L, LL. LV IL J. JVI JI <br />:: ay' pii � 5 4 Ay s" • r: <br />Pleats pdntarrype.ffor4,ign5df,m sae 61101116172 p1td 1) <br />IV U. I IIV 1 <br />0, Form Ahomvad. OMB No 2nFD-ang <br />EPA Form 8700-22(Rev.3-05) previous edidonsaf006sdets. _ DESIGNATED FACILIT1fToGENERATOR <br />.UNIF,DRM�4MRD01h, 1 Generator lO Number '. <br />c.n z fa o o �.6, 4..9 7 s <br />P8ga7d <br />E Miller `. '—= <br />` - <br />-----�---- <br />o ng Number <br />WASTE MANI T <br />'008-816929. JJK <br />S. Genera a M�pAddross GenereNls Site Address [ddMerent filen meting address) <br />PICK N�i�� <br />0987 CLARK DR. <br />STOCOON CA 9W <br />Gwrombes Phone: 209 482-19V ,E <br />6. Transporter l Company Name U.S, EPA ID Num6ara �'a? 9 3 '�. <br />D U <br />ASRURY ENVIRONMENTAL SERVICES <br />7. Transpnder2o��mQry�pp�any Name ,#� U.S. EPA ID Number <br />9. p <br />43 i aind3fteAdl(ERDOORI U.S. EPAID Number <br />I- — - . <br />2000 N. ALAPADA STREET <br />COWTDN CA 907.222 C A: x 0.9 '0 0. 1 3 3'5 2 <br />F&III IsPhone: 1311037400 . <br />go. <br />9b. US. DOT Deeuiption(mdudng Proper Snipping Name, Harnrd Class, ID Number, <br />and Pac ft Grtnp (g any)) <br />lo.Contal re <br />11.Tobg <br />12. Unit <br />13. Weare Codes <br />HM <br />No. <br />Type <br />Quakily <br />MAN. <br />7. <br />NDN-RCRA RA7J 0OIJS WASTE, UWID (BRME FLLAD) <br />D M <br />V <br />WV <br />W <br />2 FOR RECYCLING/TREATMENTATTHE <br />DeMENNO/KEP,p00N FACILITY IN COMPTON, <br />s•MIFORNIA. THIS FACILITY <br />PERMITS TO RECEIVE YOURNASTE STREAM AS <br />4. <br />14.Spadm HandNglrmsue6onsalldAddOmallydomaadan. " •" <br />EWOENCYCONTA07:CFIEMTREC 1.8"44300N1ER009B1 171"PR0FILE#9B1 M%fl.BRAICCEFI_0I)*P09 <br />A110140711 'APPROPRIATE PERSONAL PROTECTIVE EQUIPNENT /` X 5z- <br />15. 3E11ERATOR'810FFEROR'S CERTIFICATION: I hereby declare thatthe conteias of this a mirent are fully and acmlm]ey described above by the proper shipping name, end amc $*.ad, packaged, <br />marked and laheledfplacarded, and aro In al respects In proper condi for transport according to applicable intormfonal and nedonel go rammerdel regulations. If export shipment end I am ma Primary <br />Exporter, I certify that the contems.of this borslgnmerd conform to the terms of the attached EPAAGmasledgmentof Consent. <br />II that Ne waste minlmlzadon statement NentlAed In 40 CFR 262.27(x) (If I am a large quandty generator) or (b) E am a small quavery generalor) Is true. <br />Gylerat slOgemes Pdnled/Typ S on Ye <br />M.l„4 1 <br />16. lifterlitional Shipmerds <br />El Import lo U.S. El Evan hem . •.. Podd eMrylap"[' <br />Transporter signature for exports only):.' OeN M"U.&i' <br />W <br />17. TmnspoderAcliMOgment of Recalpt of Werlal6' <br />a <br />T lir 1 Pdb paC ��Q Slgnalum ebr� <br />II! G / <br />N <br />C <br />1 Rmspeder 2 Pante Name SIA ,Morek .Day Year <br />aC <br />f <br />� <br />18. Discrepancy .. . <br />1Bx. dsempancy lndicadon Space ❑away '- 11 Type Li Residue ❑Perlia]Rakim E] Full Rawkin <br />Manifest Reference Number. <br />18b. Aflemate FadGty(or Genamlur) U.S. PPAN Nw <br />1 <br />V <br />- ... <br />Fadliylgs <br />-um <br />,ec. snaPdAllanala Fir dlay(or (aenemNf).Day Yler <br />4 <br />x <br />y19. <br />Hazardous Wash ReportMenagemed Malhod Codas (i.e., Codes for hazardous "ata In apneM, disposal• and recycling systems) <br />h <br />20, Designated Facility Omer at OparI Ceral wean of receipt of . Day .: <br />UbialelNls dove'md by Me manifest except as ncled gam gEy <br />Prime Name 3"m, ,.. n Year <br />t <br />EPA Form 8700-22(Rev.3-05) previous edidonsaf006sdets. _ DESIGNATED FACILIT1fToGENERATOR <br />