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9 <br />Oct.22. 2012 1:34PM: <br />PI@a a print or fyps. (Form deal nad for use (Aeilta (12-pll 'tar). <br />• No. 1160. P. .3 • <br />°..•"" „"'" '"" " GENERATOR'S INITIAL COPY <br />1.Garsmtor'w NuMber Fam roved OM9No.20SIM <br />'UNIFORM NAZARDOU9 2. Page 1 of J.Eorergen�y RdaPuiaa'PMna ' 4. rM1t Tnm gumy� {{r�� qpV/ <br />WASTE 111ANIFEBT Pi L -rJ fl fl 2 6 9 :3 7 5 .... 1 ),4249300 ., <br />009g ''}U,Y� �Jn. <br />5. GRAM We Name and'Mhi��l�pgq Address <br />IaIL'KNRUILflSf[! GNlaralayaSdsJuldtaM(Etlmarentawnmalingaddre��). <br />VOCKTON CA _.. <br />Gummloys Phone: 209 662-1927 <br />6. TMMpoaaf 1 Garoury Name. - U:S. IU Numbaf <br />ASKIF;i"RONKMTALNIR1410E-S f A U O 2 9 3 P Y n 3.6': <br />1. Transporw2Company Netne - U.S, PAID Nunhr'!' G <br />8.Deslgraled FadityNema and SYeAddresi <br />.. . U.S. EPA 19 Number <br />t713hWAtp t KERgL1UP1 <br />MIXT Y <br />OMALAW-DA <br />IT 6A CA . 9Q; 2 C 'a► 't. n A' U' 4 1.7 S x <br />FeWifsre Phone: <br />'.. <br />ga, 9b. U.S. DOTDeaodpflon(IndudYg.Prcip1.MP0ng NamelWnddOM, IGNumbeS 10- <br />HM aM Padwg Gmup (Y any)) CaMahxs . • 11. TOtal .: 12: Unll <br />No. - Tjge Qeangry 'WWd. .... 18. YMMecod" <br />x <br />t: <br />I'KNOCfiA AZAR00139 WASA LIQUID (BRAD FILLAO <br />C <br />M <br />2. <br />W <br />F <br />3. <br />14. SpaUBI XBndirg lnalnakpna end Atldtlonal n101naeen. '. - <br />f�n+[R�EPif;'r GOhfi'ACi�CMF.ilA1ReC 1800.124�p(INFER(l#�t11�171•PRtKhlk11691:2@1�OB9Ni4iEFl.tlld`pfNE . <br />A11C11472W * APPROPIR IE PERs(NC PPOt tlit t e^Wpn NT <br />1S. OENERATOFVSIOFFEFtOR'S CERTIFICATION: I hereby dederethalihe comerYa of lhla mnelgnmanl are Mry and awralaydagbdtie0 show bytlte hropMehlpping rerlta, aldN dMaXpd, pagXogad, <br />•thanked <br />and labeledlplacardad and are In all mapar* In proper condltlon forbanspod aavrdfng to applaable lmemallmalgnd neftlS <br />gpygnin". regdMMwla.; umprtahlpmeritend.l eniMte PAmary.. <br />Exporter, I cediy that did conlanMol els consignment mntsgn)a are tame W the attached EPAAdmarAsdgmant al CarrtML. <br />1404that thewaets mlNMratbn Statement ldentMad ln4OdR 212.21(p) (Ml am ajar" quaney genareroi) a (b).(nl am a small quanNly genamror) IsyrM, <br />Oen emolslOffN01SPriMed(Typed Name <br />sjgnatm ,. <br />/ <br />ru <br />16 lhtema an Snpat"s <br />❑IrcgBdrou.a LJ Export hom U.S. portbfwityle7n: . <br />Transppdarslgnature (hrmdoms d Dste lssNg U.3•: <br />w <br />17.TranhpadarAdomat4mentof RacelptofMaueals <br />C <br />TTsnepQW1 PdntedMpgd N e y .' <br />C <br />Tmral)D v2 Rbue MNamm Mptrtlt Day Yaer <br />.. <br />18. INcrapalwy <br />II.''.''II <br />18u. Discrepancy Indication Spew ❑ Gua_�ro1Y ❑Type ❑'Reddya ❑ Pedlel Ra)aOYgl 1�,1 FuY Reiacboh <br />MaeYed RMarance Nu bar. <br />thh, AMarlala FapYhy (a Genemta) U.S. EPAID Numbw <br />J <br />U <br />Faq&/a Phone:. .. .. .. .. .. <br />w <br />F <br />Q <br />19c91gns1ure ofAllamale Fadlly(ar0anera - - <br />.. .. MONK Day y4w <br />z <br />N19. <br />Nafard2s Waste ROW Meragamanl Method (34do9,(I:9.,066" for hazardous waste aaabnerd, dlepOMl, and "q systema), , <br />s <br />20. DmWated FaUk Ownerm0peremr.,Cerlehmtlai of recelptof haU*W ffa d6 W*rad bd the momTMtezmpt sanded In Mem tga <br />jII <br />n ams nature year <br />con <br />e...... 07M in re_.. ks <br />°..•"" „"'" '"" " GENERATOR'S INITIAL COPY <br />