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pleesa dnlatype. Farm designed for use on elite(12-ph lypeveriler.) Form Approved.OMB ND.205D0039 <br /> UNIFORM HAZARDOUS 1.GaamatrIONumber 2.Papetof S.Emergency Rasparae Plwne d.Math alT acting Number <br /> WASTE MANIFEST 990 5 "t 40 0 '085492 JJ K <br /> 5.Genesis Name and Mang Address Naneretofe Site Addmsa pfdMment Oren mailing address) <br /> Pick H Pull —Stockton 3927 Clark Drive Attn: Doug Grose <br /> 3927 Cleric Dziwe Staak+C&6, CA 95205 <br /> Stockton, CA 95209 <br /> Generatar's From: al 9 4 n—19 Asr <br /> 0.Transporter I comp fey Nam D.S.EPAID Number <br /> worldwide Reventrazy Iil Tmc <br /> 7.Tiansponar 2 Compam Name i, U.S.EPA ID Number <br /> Indasct=' taste D - i�ati <br /> &Designs FeoTdy Namaand9TAddress I GS.EPA ID Number <br /> AA Sydcol, LLC. ' <br /> 1925 S. Yaestoz Ave_ � <br /> Yiasa, As 05365 <br /> Fedgh's seem: 920-763-3676 <br /> yA n.U.S.DOT D"MIPe64 Onduding Proper Still Name Havard Class,ID Number, 1o.Canldnero 1I.Tow 112UnI 13.Waste Coda <br /> KM and PacliNGreuP(dany)) Na. .Type Vie' <br /> 1-Hoaa—$C9A Hazardous Veste Solid (oily 352 <br /> o Absorbent, Debar") el Q! P <br /> a I[ <br /> 2 . <br /> 4. <br /> 14.SPMW Needing hamrmone and Additional Information <br /> 1) Si5727-BLi <br /> 11111 to wozldaride; Dear J"ropiate Protaativc Clo{bss>4 <br /> 15. GENFAATOR'SIOFFEROWSCERHHGTION: I hefty decleve 00MemMmde oftllb consignment are Wlyand amor tydeWhea amus bylha popm aNppugnama,mdam dvelTK0.padmAod. <br /> marked and MVeledlpleamee,and eie in all respects in proper mndil on for VanspadamorGng In sppluble mtametare and referral governmental regWagona.if aapod shipment and I am the Primary <br /> Bapadm,Icw*met Vie contents oftel mnsigrvnanteonfem to the mrma ofeM aaathad EPAACImMa4pmBmof nt <br /> I u*go Ina wasterenlmDaBanatatemmntW aliedin40CFRM77(B)(dlarealogequentdyganemun)or(b)(ill a smogquanh'typanemlortN11118. <br /> elNa`5Rffamrs No yped Ne me 51 new ( IdaPIn 1) Yes <br /> F 1E mmnagonel5h proems ❑import to us' ❑Expartf mu.s. AHofeneyreal: S <br /> Z <br /> Transporter algnahae(for espoas only): oyez leaving D.S.: <br /> if.lagfpgtar Acirawltapinenl of Reslpl of Materials 1 <br /> a. TnrSpagar l Pdite"pe ams Signa Month Day Year <br /> o ,f� 4 l c7 <br /> MW <br /> ranspodm x /yped Name 9gnalum l Manlh Dey Yam <br /> d5 i4 a6rs 3 <br /> 136 1 <br /> } 1B,Dlanepancy <br /> 1Be.DISMancy lndoadan Spam Quantity EITyPe ❑Redd ❑Pediel Re)ecdon ❑Full Rejection <br /> Merv'sal roma Numhr. <br /> He.Alternate FadRy(mGenemior) U.5.EPA m Number <br /> J <br /> U <br /> FadBty's Phone: <br /> 18a slanalum ofAaemate WRY(or Generalori Month Day Year <br /> Z <br /> y10.—HaWomftleR ManegemenlMelhad Codes O.a,mdse lorluLalloua waste Veelmonl,disposal,and rocydugey ms) <br /> A 2. 3. d. <br /> 20.0 n Farsily Dverer or Ogler;Caren n f mmfpt of haaardwi mme WB mverW by the mnngest mil as In <br /> It Pn ed Name wg � moo D <br /> W <br />