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:< ATTACHMENT 1'.- <br /> 410 <br /> Plelse prMaxdesjgred for use On elite.12-pitch) pewrjtei.) Form Approved.oM8 No.2050-0039 <br /> UN.ffO DDUS 1.Generetor lD Number 2 Pao( 3.EmugenryResponse Phone 4.ManNest Trac king Number - <br /> wA$TE (FEST CAL 0 0 0 4 , 0 6 $ 2 -,4. 747- 1012296148 JJK <br /> 5.Oe2evatWoesk'H Name alts Mailing Address Genomofs$itoAuumas(if aiaerent Man mailing address) <br /> Oak hlartsx Frani Inas,Inc Att:Tim BaitYi <br /> W <br /> 07$Loomis, kaon <br /> A 96205 <br /> naporter 1 Company Name U.S.EPA ID Number <br /> K-VAC Erwironrriental Services - CAR 0 0 0 , 6 3 0 9 7 <br /> 7.Trenaporfer2 Company Name U.S.EPA ID Number <br /> i Y ,�nr ,�5 �kCMfNlGtcg <br /> nz <br /> OLiJT lop <br /> 3k' <br /> 6fr.Dt.3d �b� <br /> B:Reagnated FeotleyNameaM Sita Atldress U.S.EPA ID Number <br /> Veolla ES Tect"cat souuBons <br /> 1704 W,'First St. <br /> A2use CA; 91702- <br /> too <br /> 1'702- <br /> - - ? <br /> ,gin 9b.},$,`DOT Doscripbon(including Proper Shipping Name,Hazard Class,ID Number, 10.Contalners 11.Total 12.U <br /> HM and Padang Group(d any)) nit No. Type Ouandty Wt.Nnn 13.Waste Codes <br /> o OL <br /> UN 1268,Waste petroleum dlatltlates,n.o.s. <br /> 3,PGitl, RQ fD001) 913 <br /> LF 55 <br /> 2 UN7903,Waste Flelnmable Ygkdds,n.0 s.(acetone and petroleum 1 0002 2,2 <br /> 0 <br /> X 3 4110101"),3,PGIL(DD01) ( I ol` © � D00 331 <br /> Nonl Hazardous waste.pquld(ash oil) . <br /> JM Z20 221 <br /> 4. <br /> +4.Speael Handling.Msauotons and Ad6tional lnformatlon�H�aN V caal�,lfA <br /> �a. t11' rzs�i7: "# O1Sb95 „`9x(31 P ofilo # 01G 92 P �fAc < # rrnh_n59 <br /> 9A, (2) Profile # ,975183 - Lab Peck. #1 Wear appropriate PPE EP, ?4128 <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATION: I hereby declare that the corBnis of this consignmmanefmy and accurately described above by the proper shipping name and aredmffed,packaged, <br /> marked alb labeledlplamrckd,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.if export shipment and I am the Primary <br /> Expoder l cMiy 9 the contents of this consignment conform to the terms of the attachetlEPAAcknuMedgmenl of Consent. <br /> Iced FM, minimization statement identified in 40 CFR 282.27(a)(d lam a large quanbty generator)or(b)(if Ism a V amity ge tor)is true. <br /> Ge d Pn d Name ^ _ Signa u Monts y Year <br /> F 1sMiarna spm s C` j' I K3c 8 1 O3` Ib <br /> LJ import to U.S. ❑Expod from U.S. Pod ofM41exit: <br /> Thaiepo signaWre(foisxportsomy): Date leaving U.S.: <br /> of 17::TranspoderAcKh"Medgmant of Receipt ofMasmal, <br /> T r1,nmmTyped Name' ' Signature Day Year <br /> Momh <br /> a ILt1Tn t kO AA—r-V A\L t� <br /> = 7ransDoder2 PdntedITyped Name SignaNre ManM Day Veer <br /> < rtt Mr M u✓ s' Yea <br /> 1 18 Discrtpancy <br /> 18a Disc epang incl a on SPace <br /> .❑ Ouanh'ty Q Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 1 2� Paint . ks A$ <br /> ,186:Alternate Facility(or Genalator) ManBpt Reference Number. <br /> _ U.S.EPA ID Number <br /> LL FaplilysPtyinel <br /> < 186,,Signals]e o Alternate Facility(or Generator) Mans .Day Year <br /> 2 <br /> *e Nazamow Waste Report Management Meawdcod.(Le.,codes for hazardous waste treatment,disposal,and recyctlng systems) <br /> 2: 3 a. <br /> 2 di„ gnatedF Owner or opera rtfication of re 0 of haraidouematerials covered by Me cgpt as noted in 18a — <br /> e a <br /> ^ M M y ear <br /> EPA mr 22•(Rev.3-05)'Prevlous editions are obsolete. N <br /> DESIGNATED FAC LITY TO GENERATOR <br />