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Oct. 22. 2012 1:35PM <br />PINSe lodn Wr tVoe. (Perm daelonad fusses nn HIND /19.mM�wfm.a <br />• No. 1160 P. 6 <br />,n .0 mm w vo cc l„e., ,, rmn metro mtl OV60luie. <br />............e.,......-vv.rnm _.. <br />GENERATOR'S INITIAL COPY <br />y�r <br />FWRI Approved. OMB No, 2050.0039 <br />UNI RM HAZARD WS 1. GanarewlDNumtrer 2, Pagel cl 3, Emmpenry Response Phorm <br />�. �. � 0 � A 3 � g 1 ,� 5 1 M(e�nN(ea�t Tree np Numhar�+ <br />C A L <br />�j <br />n� A94-!�. a" � V U 8.L J 5 P 5 3 JJ K <br />ASS�TIEE M�AaNIIFEarS�drAl�.g <br />�� <br />fi ` �s+r`.Pd 1' T1 PII.I:L1 T§WANITLF S `aTMKTON LLC Generators Sita Address (tldi erentlhan meting address) <br /><tM CLARK OR <br />STOCKTON CA OM <br />Generebra Phone X*4Vg) 1921 <br />6. TrainHar 1 COIn n Name U.. EPA INumber <br />A�BLIRV F t llaahM DC <br />ENTAL, f pViCr 3 A 0 0 2 a 2 T 7 A 3 6 <br />7, Tmnapader 2 Company Name U.3. EPAID,NVmlar <br />B. Dee �q <br />)t 1t1L R1�I(iES U.S. EPA ID NVMW <br />IG16 SO TH RNER i0m. <br />WESTSACRAWNTO (A 966(11 <br />Faciliryb phone: W9?.171-947 - C A 0 0 4 4 0 0 3 5$ 6 <br />ga, 9b.U.B. DOT Description bnduding Proper Shipping Nays, Herard Clens, ID Number, 70. Cantslnere 11. Tocol 12. Unit <br />HM and Packing Group(Ifamp. <br />Na. Type Quantity WUWI- 13. Waste own <br />1, <br />o <br />WARM 1{A KrW.1.iB WASTE, LIC2U O 6 Y4-fY1.FNE trY.,YC4)l � <br />4a <br />2OLUTIONS) U 9 i T' <br />z <br />2 <br />w <br />LD <br />3. <br />4. <br />PFF <br />14. SPedal Handing Inaeuclions anclAddlihonal InImmoslinn <br />MAER(W WI 171 "PfaOM F OOM : (10112ENFAU 14Y "TACT. f1F#r -REG O 4$d• i `All ii[NWN CPA Ci�S <br />Wl ' , NON(' APPROPRIATE, PERSOW PR OTECTIVE EWPM-NT <br />r, <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that theMIMI& of this consignment are lulN and accirmlaly described abm bythe proper shipping name; slot are dassN � <br />maresdeM labeledyplacardad, and am. in all mspecu In pmper condition for trans damfolin to - <br />po g nowlebgmarloatlanalandnationalgovemmenmlreguletlms.IlaxpedehipnenlaMlamme.' <br />Erpoder,lcergly that lha contents of Ms consignment Means bthe b1r1180flhe attached EPAAdmowledgmmldConsan. <br />cerbythetmewmstenNnF n6matatemmtldentlllad 1640 CFR 75227(a)(dlan a large quant!"Oneremr)m(b)(bl amasmallquentaygenemtor)ISMm. - <br />General ordOffemrc P&(Nipyped Nana: 5 nature +!' <br />/ U N j Day Yea( <br />+ _ <br />! <br />10. International SNpmenit ' <br />'❑Im.,t to U.B. ❑Fxpodhpm U.S. -Podol'9IIby(a <br />z <br />Tranepuder wgnaNre(for efporlaonW: <br />'" Date lee In U.S., !'+ <br />WrdM <br />17, TpaderAchnowledgment olR 0I0l Materials <br />) <br />r <br />oo <br />Trencpgler 1,p�lnleNlyped Name S®nMlre I i Y, all <br />V/4 Moth <br />1ra1.poner21dnlaNTyped me Sipnaaw ,i Month Day Year <br />Necromancy <br />�ta. <br />. <br />154. Discrepancy Ind cadon Space ❑ Duanaty, ❑Type ❑11esMu9 LJ Panton RejaSiim ❑Full Rejection <br />} <br />L <br />Mefhd Relerene NurMrer: <br />15b. Alternate Fadtiry(arGenerelorJ � U.S. EPAID Number <br />V <br />W< <br />w <br />Faceitya Phone: <br />1ap'Slgnature olAlemato Facility (or Generator) , Month Day Year <br />z <br />19. I -I mrdous Waste Report Mahsgeinenl Method Code. (Iecodes for hazardous waste Imatirent, disposal, and recycling systema) <br />1. <br />ca <br />2. 3. 4 <br />20. Designaled Fe0140 W Of Operator, 00000110A of receipt Of Ardous matedakscovered by the mandrin e%ceptas noted in Item ISO <br />Printedflyped Nalnu - SlgnaNm Month Day Yur <br />Co. <br />c,...., o,nn <br />,n .0 mm w vo cc l„e., ,, rmn metro mtl OV60luie. <br />............e.,......-vv.rnm _.. <br />GENERATOR'S INITIAL COPY <br />y�r <br />