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ATTAQ,WENT H (PAGE 1) <br /> Pie $a print osly pe.(Farm designed for use on elite 02-pitch)typewriter.) * Form Approved.OMB No.2050-0039 <br /> I? N�. RM HAZARDOUS t.Generator ID Number <br /> U +Oen <br /> f g posse Phone 4.Manifest Tacking Number <br /> WASTE MANIFEST C A L 0 0 0 4 1 0 6 8 1 2.Page I of 3.Emergency Response <br /> 209 747-.39M 1012296099 <br /> 11 2 y(] (1(](y ��y <br /> 5Gaiaa Harbor <br /> andelp Atliess a Generators Site Address(if digerent men mailing address) G.e7 1.�a7 c� f� <br /> Oak Harbor Frehgpl�i Lines, IrM <br /> 3018 Loort Rd.,Stockbn <br /> ,Stockton CA 95205 <br /> Generators Phone: 2 0 9 4 Fa 7 - 7 3 4 0 <br /> B.Tansporrer l Company Name - ' U.S.EPA ID Number <br /> K-VAC Environmental Services CAR 0 0 0 1 8 3 0 9 7 <br /> - 7.Tanspurist 2 Company Name. U.S.EPA ID Number <br /> Vt'DLIA is '(.Clf-1rJf�"tR'a. .3OLt471APS - N"5� 0&O b3i3b�' <br /> B,Oaegnmed Fedlity Name and Site Address U.S.EPA ID Number <br /> VeOla ES Technical SoWBonS <br /> 1704 W,First 51, <br /> Azusa CA 91702 <br /> F22i e!Pndne 395-8726 C A D 0 0 8 3 0 2 0 0 3 <br /> ga, 96.US! 8t]0 70esWpgdn ginduring Proper Ship 0ng Na me,Helped Class,ID Number, <br /> HM and Packing Group(ff any)) 11.110141 12 Unit CarMelert 13.Wake Codes <br /> No, Type QUW* WIAId. <br /> o UN1993,WASTE tiarrfinetYb liquids,n.o.s (acetone and paV . <br /> oleurn 213 212 1 <br /> X distillates) 3,PGIt,RO fDO01). (lab pack) <br /> pull <br /> X 2NA1993,CaTglgustble Squid,n.o.s (PetroleumsflNetes), Pall ` 343 <br /> DMt <br /> 693, <br /> x Bisuhhtes,aqueous solutlons,n.o.s. 141 <br /> Ptulll <br /> TP <br /> 41iler�-RCRA'Hazsrdous waste,solid(dried absorbent and primer) 352 <br /> t- one I 0 P <br /> 145peaal He Itp Mhoctiorb arMAddtlon9 ktfuttnetlott - <br /> proPa Ye #9— <br /> '61G3 - ERG a 126 LIP 1 <br /> 316.2) Profile y 976181 ERG a 126 <br /> 9b,3.) .P'rnfile #976186 ERG -a 154 <br /> i3b.41 Pill 091617 W/0 KN16-Oya,/ Wear PropelPEE when <br /> 15. hanai in ra-.ce <br /> GENERATA,*'SIOFFEROR'5 CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplaarded;and are in all respects in proper condition for transport according to applicable international and national govammental regulations.It export shipment and I am the Primary. <br /> Exporter,I Certify that the contents of this consignment conform to the telcos of the attached EPAAcknowledgment of Consent. <br /> I certiN that the waste mimmdetion statement identified in 40 CFR 26227(a)(I1I am a large quantity generator)or(b)(NI arp a small quantity generator)is true. - <br /> awDr`slOHemrs PnmediTypeq Papil S' zure a <br /> MOMh Day Yar <br /> F 16:Intemstlonal Shipments �` 10 Z I/6 <br /> z ❑ImpcNb US: LJ Export from U.S. Pat ofeneylent <br /> TransDortersgnature(faexports ontyJ: <br /> w Date leaving U.S.: <br /> 17.Tran <br /> sportenAcknarledgment otRebeipt of Materials <br /> 0 Name <br /> r er IPdntedRyped _ Signature Month Day yam <br /> spor . . <br /> y -LNIia1t20 �ReUf�l.r✓ Q3 QZ <br /> a Tansporta2PdnleNTypedName SignatureMonty D --, Ya, - <br /> perM°M/C}for - JL <br /> } 78: 03 7 <br /> Discrepancy -. - <br /> 18a Discrepancy indication Space ❑ OuanMy ❑Type L1 Residue ❑Partial Rejection 1:1 Full <br /> Rillection <br /> Manifest Reference Number: <br /> 166.'A9emate facility(or Generator) U.S.EPA to Number <br /> J- <br /> U u <br /> LL Factity's-Phone: <br /> w 18c.Signature ofAkemate Faality(or Generator) <br /> Q: Month Day Year <br /> - 19.IW rtlou este port MenagemeM Method Codes(i.e., as for hazardous waste treatment,depose, tlrecycling systems) <br /> ted Facility /ler or OOppeabr C cation of iaceiptof hazardous materials covered by the me 'IFes Except a nrted (tem 18e <br /> ` It reM6th r�Year <br /> EPA Form 8700-22(Ree3.OS) Previous eddtons are obsolete. ` <br /> I DESIGNATED ' <br /> E IGNATED FACILITY TO GENERATOR <br />