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Please print or type. Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.205x0.0039 <br /> UNIFORM HAZARDOUS 1.GNumber <br /> enerator ID Number 2.Page 1 of 3 Emergene/Response Phone 00so®"91®4 DAT <br /> WASTE MANIFEST t o f' r r . Z 7 1 3 <br /> Gene <br /> 5.Generator's Name and Me"Address - ak/s site Pddress(N d�Merem than maNing address) <br /> Tesoro USA <br /> 150 Soleno Way 2560 W.Lad Asrerxle <br /> Pacheco,CA 94.553 Lod,CA 95242 <br /> GenerelWs Pm425.228-12Yil <br /> 6,Tmnspakr 1 Company Name U.S EPAID Number <br /> EA'Aromiettal RenFaBes,im CAL000371038 <br /> 7.Transporter 2 Company Name U.S Number <br /> UNI Waste CALOIX131737D <br /> S Designated Facility Name and Site Address Altareorill <br /> LAr4 9 U.S.EPAID Number <br /> CAd)881382732 <br /> 10840 Allleatoat Pass Rd <br /> LWermove,CA 94560 <br /> Faaws Phwre925-455.7" <br /> ga 96.U.S.DOT Description(mdud'ing Proper Slipping Name,Hazard Ckss,ID Numbs; 10.Containers 11,Total 12.Unit 13,Waste Codes <br /> HM and Packing Group(ianyj No Type Quantity Wt.No4 <br /> X 1. R.Q. NA2212,ASBESTOS,9,PG III BA Y 151 <br /> 0 i <br /> w <br /> z <br /> JUN 2 4 2016 <br /> 4 W. ..� ...-- <br /> 14.SpermandNngnsimams and Additional Information <br /> FRIABLE ASBESTOSCONTAINM WASTE/BAACMD 9139 ELLIS ST,SAN FRANCISCO,CA 94i0WTRAN5PORTER 1-ERI 3910 VALLq <br /> AVENUE,PLEASANTON,CA 945196,925461-3265/TRANSPORTERAM <br /> 24JM WASTE 17100 LAMBERT RD.,ZONE,CA 95940 q' <br /> 14.1464 rP 1 <br /> 15, GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the=tents of this consignment aro fully and socuretetydesafbed above by the prepershipping ranks,and are classified,packaged, <br /> marked and labeledlplacmded,and are in all respects in poper condition for transport accadmg to applicable international and national gwemmental regulations.If export shipment and I am the Primary <br /> Exporter,I certity that dks contents of this comgnment corlam to the Ams of the attached EPAAcknowledgmem of Cansent <br /> I caddy that the waste nununixation statement identified k 40 CFR 262.27(a)lift am a Large quantity generalor(or(b)(if I am a small quantity generator)is hue. <br /> Genormue ORaWSPriniedlfyped Name gna / Al ytrs F'� J(r.rl.. Month Day ear - <br /> •', 7 - 1 ) _i yam. <br /> "Al 1 x\ (` 11-7\-111 G <br /> 6.hurnaffional Shipments ❑Impodto U.S. El Expert h.U.S. Partofestwexlt: <br /> M Transporter sgnatumffxr exports onlyy Date leaving U.S. <br /> w 17.TransporlerA.cknowledgmenl of Receipt of Materials <br /> renspoMr nWFyped Name blre y Yea <br /> z Tmnsporter2 d eme Signature Menti Day Year <br /> 6 f /4 <br /> 1 <br /> 10.Dlscreparwy <br /> 1 Lea.Discrepancy Irdrrabon Space ❑ Ousemy, ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manilest Reference Number: <br /> I&Alternate Facility fa Generator)GeneratoU.S EPA ID Number <br /> J <br /> U <br /> LL FarAty's Phone: <br /> W 1 Sgnatureol Aftemale Facility(a ralori Month fay Year <br /> zZ <br /> CD <br /> 19.Hazardous Wask Report Management Method Codes 0,&,codes for hazardous waste treatment,disposal.andrecyding system)w0 1 2 3 4. <br /> 20'Designated FaclNy,Owner a Operator:Certifncahon of receipt of hazardous materials covered Doe manifest except as Med In nem 10a <br /> 1nled yped Name�' gnaw a Day Ysm <br /> (-- fix.( /)� 4 <br /> EPA Form R700-2 (Rev,3-05) Previous e6fions are obsolete. DESIGNATED FACILITY'S COPY <br />