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0 0 <br /> Please punt or type.(Form designed for use on elite(12-p¢dh)typewriter Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS ..Geneam ID Number 2.Page I of 3.Emerg9ncy Resocnse Phone 4.Manliest Tneldng Numbv <br /> WASTE MANIFEST CALOOD269375 1 877-737-5277 012867532 JJ K <br /> 5 Caneratofs Name and Mailing Address Generators Site Address(8 different man muling address) <br /> Pick H Pull —Stockton 3927 Clark Drive Attn: Doug Grose <br /> 3927 Clark Drive Stockton, CA 95205 <br /> Stockton, CA 95205 <br /> Gereramrs Phone: Via 74n—aciaF <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Industrial Waste Utilization CAD9B0585293 <br /> 7 Ta-sc,ce•I rcmpany Name U.S EPA 10 Number <br /> Worldwide Recovery S stews CAR000175422 <br /> B.Designated FauFry Name and Site.Addrass U.S EPA ID Number <br /> AA Sydcol, LLC. <br /> 1925 S. Factor Ave_ <br /> Yawn, As 85365 <br /> Facaity's Phone: 928-783-3676 ASR000501510 <br /> fa 9b.U.S.DOT Dewmplian(indti ing Proper Shipping Name,Hazard Class,ID Number, td.Contamam 11,TOW 12 Una <br /> Hid and Packing Groupcdany)) No. TYOa Quaintly WLNy_ 13 Waste Codes <br /> 1. on- Ffacardous Waste Liquid (Late" Paint 291 <br /> Ad Colsodity Peak) I OM 160 <br /> K 0 P <br /> r V <br /> w <br /> 2 <br /> cd <br /> 4. <br /> 14 5bewl KarANInsltudRns and Addlsonal information <br /> 1) L1'/888-CP <br /> Dill, to Worldwide; Wear Appropriate Protective Clothing; ER Response# Worldwide Recovery <br /> Sys,_ .Inc_ ; WO# 265040 AL <br /> 15 GENEUTOR'S'OFFEROR'S CERTIFICATION: i hereby declare that the contents of this consignment an kdly and)=rarely described above by the proper shipping name,and are Classified,packaged, <br /> markedsndfabeladfplacafded and are In au respects in proper condition for transport according to applicable international and national govammentai regulations.If <br /> expos shipment and I am the Primary <br /> _xPoreOl teryNmet to=fords of mie consignment wnlortn 10 the terms of the attached EPA Acknowledgment of Consent. <br /> r CertfyInaf the uaae mitnmitafbn statement identified in 40 CFR 262.27(a)IN I am a Large quantity generatoR or(D)(KIM a mall quantity generator)is We <br /> Cmrvaawelu' 1c sPdntedrfyoed Name Signarura Ma"m Oay Year <br /> F '2 m:a..a SNpma ❑Impart to U.S ❑Eapw lmm .S Pon of ewyz.t <br /> Trarspwr vgna"re(lar a+pons otyf. Dere leaving U.S.: <br /> w 17 TnnspmlerAcklroMedgmwtofReceiptof Matetuls <br /> Trm tFnrted�yoed Name (' x/11 SgmNre Monro Day Year <br /> N r V ` Z r <br /> Q Tmnsporaw 2 PdmedfTyped Name Ci�N Monro Day Year <br /> C <br /> H <br /> 18a Discrepancy Indication Spam (1, <br /> Cuanlay ❑Type ❑Festdua ❑PadlalfteleNon _FUN fte;ator. <br /> aAanawl Reference Number. <br /> 15b.Aerials Facility(or Ganeratoo U.S.EPA ID Number <br /> J <br /> U <br /> rai Fedfityr;Plane. <br /> W 1ec S%gnatundfANsmam FaNay(aGenentr) Monro Day Year <br /> Q <br /> 2 <br /> y19.hazardow Waste Report Management Method Codes(i.e..codes for hazardous waste lnatment,dsposal,and moydingayslams) <br /> O t 2. 3. <br /> I ,20.Designated Facility Omar or Operator Certificebon of mcelpt of haZarddpa materials covered by the manffest except as noted in Item 18a <br /> -wima+Iraq Name 5igraNre Month Day vast, <br /> cPA.Form 11700-22(Rev.3-05) Previous editions are obsolete, DESIGNATED FACILITY TO DESTINATION STATE (IF REOUIRED) <br />