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DTSG. 06r?30. 1485 <br /> Please pnnl or type.(Form designed for use on elite(12-pit0h)typewrites) Form <br /> Approved.OMB No.205D0039 <br /> ` PlIG50BLY0"S <br /> ORM HAZARDDUS 1.Generator ID Newer 2.Pagel of 3.EmergencyResponse Phone 4.ManN T=Wng Number <br /> STE MANIFEST C A C 0 0 2 0 1 5 2 1 2 1 00 321-5479 002141252 JJK <br /> •` ' Name and Mail%Aaddress Gener"s Site Address(8di8erent Nan mailing adder) <br /> IDER DHOOT DALWINDER DHOOT <br /> HARLAN RD 15888 S HARLAN RD <br /> 'ATHROP CA 95309 LATHROP CA 95330 <br /> Genarc xs Ph": 2 0 9 2 7 5 - 2 7 0 8 <br /> -.Vote 1 COmpeny Name U.S.EPA ID Number <br /> Eco og},Contrnl Industries A D 9 8 2 0 3 0 1 7 3 <br /> 7.Traraponer2Company Wore - U.S.EPAIDNumbor <br /> e MPNRrV SE'I'V XE� ECH JEAST PALO ALTO U.S.EPA ID Newer <br /> 2081 BAY ROAD <br /> EAST PALO ALTO CA 94303 <br /> Facl6(sphwM950 324-1838 A D 0 0 9 4 5 2 6 5 7 <br /> 9y 9b.U.S.DOTDosaWn(ndWittg PmpMShWNNMre,HmdCbMIONuwa, lo.Contanen <br /> .HM ark PadingGnatp(dany)) No. Type IOuawy 17 UnWVVa�II. 13.Waste Codes <br /> STE Flammable liquids,n.G.s. <br /> oX 3.UNf993.III(Gasoline) <br /> .. � 1 TT 0400 G 13 1301 018 <br /> z 2. <br /> W <br /> c9 <br /> 3. <br /> 1ECE? <br /> IeSOB Wgm52T336°onalIMo "bon PROFILE #383823 ERG#128 <br /> WEAR PROPER PPE WHEN HANDLING_ WEIGHTS AND VOLUMESAREAPPROXIMATE- <br /> ECI PO# gnA:�.� <br /> 15. GENERATDR'SIOFFEROR'SCERTIFICATION:I hereby dedam that the contents of Na consignment are Wy and accurately described atom by the proper sl4png mane,9ld are dassified,packaged, <br /> narked and IabeleNplacanded,and are in az respects in proper mndtlon for transport according to applicable international and mytonal govemmentel <br /> regulatiaa.NeWrt shipment and I em the Primary <br /> Dprorter,l certify that the coolants of Jus mndgnmeM conform to the tetras of the attached EPAAdnerledgnunt of Consent, <br /> I certify Ua18ro waste metrication statement identified in 40 CFR 262.27(a)(8I am a large quantity generator)or(b)(al am a small quantity generator)is true. <br /> rs/OBerofs Pmd1edW Name Sig Day Yw <br /> LM 11 1451 <br /> 16.Imi matknal Shipments <br /> ' ❑Import to U.S. ❑Eapod .5. Pat al entry/akt> <br /> = Transporter signature(for aapods onM): Date leaving U.S.: <br /> W 17.Transporter Ackncefedgmenl of Receipt of Materials <br /> Tran r 1 Pantedrfyped Name Signature Month Day Year <br /> O <br /> aia Z U <br /> Q Trenspater2 Prat NT Name - nature Mon Day Yeter <br /> K <br /> H <br /> r18.Di Perry <br /> 16a.Disuepancy Indication Space ❑ Ogynely ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 19D.Alternate Faclliry(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Fecal Phone: <br /> Q 18c.Sig mbum of Alternate Faculty(Or Generator) Month Day Yaar <br /> 2 <br /> y19.Harardota W Report Management McBrod Caws(i.e.,codes for hazardous waste beatrnent disposal.and recycling systems) <br /> p I. 2. <br /> 20.Designated Facility Omer or Operator Certification of WV of hazardous mahades covered by the manifest except as noted in Item <br /> 1 PdnuMype7 Name SynaWre Month Day Year <br /> nk a6 <br /> EPA Fonn 87000.22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DES INATION STATE(IF REQUIRED) <br /> 101181064 <br />