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08/13:2009 12: 36 6502664560 NORTH STATE ENVIRONM PAGE 32 <br /> Please print or to.(Form designed for cess on elite(12•pilch typewriter.) Fortes roves.OMB No 27500075 <br /> UNIFORM NAZARD0U6 I.General.l0 Numbs 2.Pegs 1 of 3.Emerpehry Response Front a.Manifest Time%Ing Numher <br /> WASTE MANIFEST C A D 9 B I . 4 7 0 5 5 1 :Z09-727-550 000116840 FLE <br /> 1 Gaammra Name and MdlnpAddren rOM814 ,Site Adarea(it dlaemnl then malAng i ddreal <br /> STAR BUILDING SITSTINS <br /> P.O. BOX 830 12101 E. SRANOT RD. <br /> LOCI MAD CA 95237 LOC2tEFORD CA 95237 <br /> Generarors Frons. 209-727-5504 70.36 %TTN: STEVE IrARRIM <br /> A.Transporter l company Name LLS.EPA ID Number <br /> Borth State Environmental (650)598-2838 4 A 7R 0 0 0 1 5 9 4 3+*' , <br /> T.Transporter 2 Company No" U.S.EPA ID Number, <br /> Rost acrid Bone Truekinq (619)443-6193 A D 9 8 1 6 3 4 1 1 6 <br /> B.Designated FICIfilm,Name WO Yle Address US,EPA IO Numbs, <br /> BIRMNS )0.TZR TECEIROLOGIES CORP. <br /> 5375 SO,. SOILS AvENt7E <br /> M a�Fau-LBB CA 90058 (323)277-1500 A 0 0 '9 7 0 3 0 9 9 3 <br /> ga. 9b.U.S.OOT Descdpsnn(Including Proper Shppmg Name,Hazard Clow,ID Number. 11).Cm4 ni It.Tolyl 12,UNI 13 VHsst,Coda <br /> HM and storing Group plany)I No. Type Ouanllly, WINpI. <br /> 1• AOM-RC117a BAZARDOUS WASTE LIQUID $' 91 <br /> CC <br /> (LRTKX PAINT) 1 Om !MP G — <br /> W rL�/ <br /> 02 (L)aTEE PAINT)KIIJARD0U8 RI STS LIQUID '!7 91 <br /> B DF &0500' G <br /> e' Nola-ACPA BAZAADOOS WASTE LSQUID am 331 <br /> (RACK SLUDGE) 1 DF 200 Is <br /> N.Sped,Handaop Inamactuna and Addlllonel Intametbn <br /> 111 ERG NRK 350708-21 , ,IOb� <br /> 2) ERG lanai 350708-21 )/ <br /> 3) ERG NM 321105-13 �2l 3a S 3� <br /> 15. GENERATOR'StOFFEROR'SCERTIFICA170N; I hereby declare Nal me cantome <br /> s of this cerognm4. <br /> Vm aro Nly and accurelety aelentsid ah"by the proper Moping We.and am clawfed.packaged, <br /> .shed and labeiadlplaorded.end em in all reenacts M proper condition far hangout According b apploble mbtnallanst and nno Ovral goeommemal IegubFaaa.II CAp.t shipmeol and I am the Pdmny <br /> Eaponer,I cMdy that ma cents nn of this mnsgrmma Corson to ne came of the Beached EPAAchnowiadgmenl of Consent. <br /> I.airy Thai ate vaek mintreallan Abowment MenlRed In ac CFA 262.27(,)(If I am a Mtge guardiry gang tar)or(b)if I am a small gu Vy ganaratslj n he <br /> anamro aro nme l ams panmatter, Usy yaw <br /> 5 a fa-ga <br /> 19.Inbmaeorel Ship"" <br /> F- <br /> ❑import to s,.5 ❑Etpbn Nom U.S port demryle,IL <br /> Transporter sl nature Ian es wean : Date bed U.S.: <br /> 17.thansponafAcknowiedt l of Receipt d Material, <br /> CRensporter I P Name Signature M y Nf <br /> a <br /> elp <br /> N <br /> n r2 nme ad Name re Martin Uay ear <br /> f Ie.DIW"I" �I <br /> Igo 01empenay lndlotlon Spam 11 Quantity ❑Type ❑Residue `I PaNtl Rejection ❑Full Releolcn <br /> Manifest RObmnce Number <br /> tab.Hamate Facility(or Generator) US EPA ID NarbeF <br /> J <br /> V <br /> LL FOCI sPhona'. <br /> w tea Slpnabac orAftemab Hour(of Gorental Mnnlh Day rear <br /> 19.Haallou.,Wait Report Management Method Codes p.e..cadet he hazardous 91 aeatment,dlspmal,and mgcRtg System) <br /> p 1. 2. <br /> 20.Dnipnabe Facilityt Open.CMlbohon azard"s maled uaad by me matdea acapl ps nalod In 116 <br /> 1 <br /> PMIeafTYpaa Name dmt SipnAue Month Day Yea <br /> Ngr lop ILA i2q-- <br /> EPA Form 8701>22(Re 3 51 Preulous odillorrs dqiibrIoIqte. Z DESIGNATED FACILITY TO DESTINATION STATE(IF REWIRED) <br />