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a • • <br /> ,Reiss print or type Form designed forum on aide(12-pidcJApevinler.) Form Approved.OMB No.2AMO39 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page t of 3.Emergency Response Phwie 4.Manifest Tacking Number <br /> WASTE MANIFEST I r 0 a3112-&5 00009104 6 DAT <br /> 5.Generators Name and Mating Address Ceneraa S Site Address(if different than mewing address) <br /> Tesoro USA <br /> 150sawra lyay 2500 W.Lod Avenue <br /> Padnm,CA 84953 Lodi,CA 95242 <br /> Generator's Phol426a28-228 <br /> 6.Transporter 1 Company Name Re <br /> ErU.S.EPA M Number <br /> 1NITartrrterthd rrredes,Inc U.S. <br /> 7.Transporter Company Name U.S.EPA ID Number <br /> UNI Waste CAL000317329 <br /> 8,Designated Facility Name and Site Address U.S.EPA ID Number <br /> Altamont Landfill CAMS1382732 <br /> 10640 AatrwM Pass Rd. <br /> LWermore,CA 945W <br /> FaciliNs,Phone925.46&7300 <br /> ga go.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Contalnam 11.Total 12.Unit 13.Waste Codes <br /> HM and Paddng Group Clary)) No. Type Quantity WLNd. <br /> % 1. R.Q. Ni ASBESTOS,9,PG III BA Y 151 <br /> o z / <br /> z 2. <br /> w <br /> 0 <br /> 3. <br /> JUN 2 4 2016 <br /> 4. <br /> 14.%;Ml Handing Insuucaons 0323-b Z771Bon <br /> FRIABLE ASBESTOS CONTAINING WASTE t BAAOMD 939 ELLIS ST,SAN FRANCISCO,CA 04100/TRANSPORTER 1-ERI 3910 VALLEY I <br /> AVENUE,PLEASANTON,CA 94580,925.481-3285/TRANSPORTER 2iH1 WASTE 17100 LAMBERT RD.,ZONE,CA 95040 <br /> 14.1484 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by im proper shipping name,and are dessiified,packaged, <br /> marked and labeledlplacarded,and are In as respects in paper coronion for aatspod according to applicable international and rebonal governmental regulations.If export sMpment and I am tM Primary <br /> Exporter,I redly that the contents of this consignment conform to the tenns of the attached EPAAdaawledgment of Consent <br /> I car ify that the waste minimization statement Identified In 40 CFR 262.27(a)(if I am a large quantity genemor)or(b)(ifi am a small quantity generator)a true. <br /> Ceramics! Oaem's Pnntedrryped Name Signalu ^� y(r /rq v, e�(h.C1'v.. +— Month y ear <br /> ,a — G <br /> ...r i .international Shipments <br /> F ❑Impartb115. ❑Export frern U.S. Pod of entry/exit <br /> Transporter signature(for exports may} Data leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Matedala <br /> ranspoMr 1 Pnntetllfyped Name Slg Math Day Year <br /> 6 <br /> 2cr / 1ST I V <br /> N <br /> ransporter nn Y naWre Mmth Day Year <br /> S � <br /> } 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Ratak. ❑Piru ffsect. ❑Full Re)ecmn <br /> Manifest Reference Number. <br /> 186.Alternate Faciy(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> u Fadkty's Phone: <br /> W lac.Signatureo timate Facihty(or Generalor) Month Day Year <br /> Q <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste Immanent,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> 20 Destgnaled Facility Ozmar or Operator Certification of receipt of hazardous materials covered by the manifest except as acted in Item 1 Be <br /> 11PtinfediTyped Nam gnatureon Day ear} <br /> 7 <br /> EPA Foran 8700.2 (Rev.3-05) Previous editions are obsolete. DIESIGRATED FACILITY TO GENERATOR STATE(IF REQUIRED) <br />