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Please print or b".(Formdeslgnal fo(use on stole 12yMch)lypewriler. Form Approved.OMB No.205GM39 <br /> UNIFORM HALIRDOIIS F:GeneralorlD f4umher - 2.Page l of 3.Emergency Response PMre. 4.M� Ta�ngRum JJK <br /> WASTE <br /> /M�AaNIIFFESTMa yp CAL 0 0 0 2 6 8 3 7 5 1 (800)4�4-mo 014051286 <br /> 5.Gen 01,143 I.L�triSO ress Genaaloes SileAddress(rid%aad tlun maig address) <br /> 3927 C12P.K DR. <br /> .STOWOR CA 952-05 <br /> Gerwrabh Plane: 203 442-1921 . . . <br /> T's"" <br /> an�G(JR •141!IRONMENTALSERVICES U.S.ECA 028277036 <br /> 7.Traepaler 2 Corm j Name _ , U.S.EPAID Numeer <br /> a Dss%-Ied Faa3ly Narc and 59eAddresa - U.S.EPAID Number <br /> VlORLD OIL•=4 JOAQUIN,LLC, <br /> 14287 EAST MANNING AVENUE <br /> PARUER 0, 93648 <br /> Fa s Phone: . _(569)498=0240:.. .. - . . - C A'L 0,0 910.2 7 b 1 <br /> 9, 9b.U.S.DDT Dewp6on(ndudug PmperShppYg Nate,Haw'd Clees,ID Number, 7g.Canb9ws - 11.Trial V.Uri <br /> HM 4MPaM^g Group III an7) - - - No. Type.• Ouamy WI13.WashNui. - 'Codes <br /> t. <br /> I4(Xi-fNRA RAZARDOLIS WASTE,LIQUID(ETHYLENE GLYCOL. 13 <br /> 0 SOLUTIONS) 001 1T. �] rG -� <br /> w <br /> 3. <br /> 4. <br /> i <br /> 14.Specht Halog Insmctlom ad AdMonW Nfamafion - <br /> EMERGENCY CONTACT:CHEMTREC 1.604424-9300 *APPROPRIATE PFRSONAL PROTECTIVE EQUIPMENT EMERGENCY - <br /> CONTkCT CHEMTREC 60442CP300 a <br /> 15- GENERATORWDFFFRORS CERTIFICATION:Ihersbydedae OW the mMan(suflNs mndpenerd aro hdlyad aoamkydesuLeda*m by Me proper WiW*Darns,aid"claed9ed.lurkaged, <br /> maladaed labekNphraded,adpebdra+perlob pmpabm&Son fa 9aupalaond/ng bappicabk bkrreBaWand lla6orul gosamcNalrepulafions Il etpal rd and lam lrePdoay <br /> Erpaler,loelgytlW die cadenls olWs rar rmsolradomrbtlro lamso(fdatledMTRhAtimm OynadorCouenL <br /> Icer6fy9u1tlewasbmWntra9onilalegieR - F"10CFR 26227(a)(dlarnala4e wr6lyyenaalor)a@J(dlemesmalpwYlly9 '+�Ik <br /> GenerafWsOk Ws <br /> 15,Nbma9mWShpmenls 0 _ U.S. Paddenbykat <br /> ❑lmpalbD,S.' � <br /> TaraPales dgature4oregoiftc l*, Deblen}ig U.B.:rl7.TrmpDduAdapWWpnddH4oeplufMaapisls ft r . .._aapeder 1 PriMeNTs7�111> <br /> Vol <br /> nspodx2PdnldRyped Name Sipraeas - NOM Oay Year <br /> 1&Dkmpacy - - <br /> 1H'mucrepagrwicadenSpace ❑Duanf)y ❑Tpe ❑Reedue ❑PadWRe)e6m ❑Full R*di. <br /> MaidaA NeMerce Numha: <br /> iBb.AllemelsFarBy(aGenaala) - _ .U.SEPAIDNwiw <br /> LL Far3ly'sPhan: _ - - <br /> tdcSO-OhnOf Alternals Farily(arGeneralcr) - k 0myLL 1141 1 Ik <br /> t7 to Haaadaa WSsle ,MasgmieMMetladCodes@e,mdesfa hazadaa rests Ysa9nenl.dsposa4 and mgsigsyalemsl <br /> 2a DWlpmted FaciRyOa mOpaator.Cwtkagonamcoof amrdmsmdahbmmdbylhemaimwmeom Med laglla - <br /> n Ai I I Z U 1301/5 <br /> EPA Foan 870D-22(Ray.3U Premus editions are obsolete. TRANSPORTER'S.COPY <br />