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<br /> y5)oteo6Colilornm-�nvlronmanlol'Pr°Iedion Agenry
<br /> Fofm Appm ; V lila 2050-OS139IEaplres 9-JO-991 See InstNctioDu^on back of FyuI6_,• Department aF m,m Substance>Camral
<br /> Pleasm prix°or type. Form dmignod fo,un an efim f12-pitch)iypaWiRec I I entto Toxic ubiCollm.to
<br /> L,Ganerolo1 s U$EFA ID N°
<br /> UNIFORM HAZARDOUS I p ' ,;,+';t Maalln(Denmgnl Na. T. Pogo l Information in lhuhedad areal
<br /> y,y�eeeeeerelWe AySTeEMA,uNIFyEST
<br /> C A D 9 8 1 4 4 7 0 5 5 9'7 7 5 8 of 2 is not required 6y Federal law.
<br /> e`ST:dkLi talflSd7IIVli OS'�� Site Address A 51.1.M.nihnt Documenl Number' 24797758 e"4."y..rt9 /!..e�'
<br /> P.O. BOX--830 12101 E . BRANDT RD. d0
<br /> o LOCKEFORD (,3.� 95237 LOCREFORD B.51a1a Generator's ID
<br /> A. Gen°mar's Phone 1 209h727-5504 X 36 CA 95237
<br /> N 5.Tromporler'I Company Nom. 6. US EPA ID Number C. Stam Transpvtbi's ID IRaserved,) 0539
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<br /> North State Environmental CAR 0 0 0 1 5 9 4 5 9 D. Tnnspo,mr's Phod -
<br /> 1m 7.Transporter 2 Company Nemo B. US EPA ID Number E. 51a1e Tmmpormr's ID[Resennd.] -
<br /> Rust and Sons Trucking I C A L 0 0 0' 2 0 3 4 4 4 '
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<br /> Q - , '--- -(,.� F. Tromparters Phone
<br /> U 9. Designated Facility Noma and Sit.Address 10.JUS EPA 10 Nmvbsr G. Slate.Foc!Vty,'s ID -
<br /> "¢ Chemical Waste Management, Inc. C i A i T .0 0. 0 .6 41 611 '1 7
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<br /> )ac 352511 Old Skvl'6e g��d -
<br /> ..� Kett Old Ca � CA93239 C A T 0 0 0 6 4 6 1 1 7 H F°`ililr''�t38b)222-2964
<br /> ,U 11. US DOT Description(Inch, 8rapor Shipping Name,Hacord Class,and ID Number) 12. Containers IJ. Tolol ld. Unit yGp�ww�,
<br /> No FTY0. Quantity WI/Vol 'I , mi.Number
<br /> Z °' NA3077; HAZARDOUS WASTE SOLID,N.O-S. , siald72.
<br /> (ARSENIC,LEAD) 1 91 PGH2, RQ.(D004) _ 7 DF 1750 Es
<br /> 3. 0' - 1EPA/01her -
<br /> E noon
<br /> o N h' NON RCRA HAZARDOUS WASTE SOLID., - " 'SW052
<br /> m E (PAINT SOLIDS,OVERSPRAY) .-3BA '.4790 P
<br /> R 'EPA/Other
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<br /> `6 T C.
<br /> NON.RCRA HAZARDOUS WASTE SOLID , slalesz
<br /> C) O (PAINT SOLIDS,OVERSPRAY) - 1 fDF 75 P ErA/other.
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<br /> Z d' NON RCRA HAZARDOUS WASTE SOLID . . 51ote23
<br /> (OIL, ABSORBENT) 1 DF300 P
<br /> U v^} EPA/ ' r
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<br /> � J. Addllional Dmcnpltom far Mvledals Listed A6eve '
<br /> Z emer-r'a0 IGl{mldling-Codes for Wast Lislod A6avn
<br /> f �. 6 -�. ....
<br /> A: EB6755 I ADD'EPA CODES-D007,r D008 - ' 171 `
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<br /> H: EH0744 NMI ler
<br /> Q C- EB8744
<br /> Q1 .'Specml andling Insn.climdand Additional I.F.neaticm
<br /> a -.STEVE WAREING 1 209-727-5504 X36 I ,
<br /> W T^^" I addreee: 835 naaonlia AVS. a^, 80. BAN ]FRANCISCO, CA 94080
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<br /> 2 addrssea: 15353 'Old ay a0, R1 Cajon, CA 92021 r __
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<br /> 16. GEWWOR'S CERTIFICATION: Ihen6y dedvre fhol l6e mnlenli of lhismmtgn mare fully and°ccumlel.described above bypropershipping nom.and°n clmilR°d,packed,
<br /> marked,and labeled,and are in all respects In proper condition for transport y highway according to applicable international and naliona government regulations.
<br /> -s II I om o largo qu°nlily ammmmr,I certify Ilial I hon o pr�ogroin in place to mduca the volume and loelcily 1 wasle generated m the degree I hove determined Ia 6e ec°nomimlly
<br /> Nproclica6le and Ilial I hhove aelealed the practicable method°t Inoiont,slarage,or disposal curnnlly awlloblo to me which minimizes the present and future threat is human haolih
<br /> and the environment;OR,if I am a small quantity generator,I hwe made a Rood faith eflon is minimi.my waste aenerolion and select the haul waste management method that Is
<br /> O ..liable 1°me and Blot I con afford. / V /
<br /> } Pr(nls��e ' ` ,n�...� _ 51gn°Nn �' l ••�F Month Day, Year
<br /> (� B 17. Treempmur 1 Acknow ori ement of Receipt of Materials ,v*
<br /> W A Prim d No a
<br /> : s / "%dam J�� TT,E-ucc.L °i,
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<br /> W N 10. Transporter 2 Acknewlad amanl of Reui I of Mvlerials
<br /> O' T Prinled/Typed Name Slgnalure Man01 .Day .Year
<br /> U F 19. Discrep ndLBen ero
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<br /> I T0. FoaYl a Csr115.Wian ahecei al Mzardem moleriah conred 8th anResl este l o+naiad in INIn•19�"" '
<br /> T Printed/Typed Hens SiRnalure 1
<br /> Y C�� bYl�. G�v111.C� ^� D9 Ycm�.
<br /> DO NOT WRITE BELOW THIS LINE.
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<br /> Yellow: T5DF SENDS THIS COPY TO GENERATOR WfiHIN 30 DAYS,
<br /> DTSC B022A(1/991 IGanergtors who submit hazardous Waste for transport out-afaky,,
<br /> EPA 9700-22 '.�"'.,� GI / �J P{, �e,, mpiotecl copy of this co and .rad 1°DISC.wghin,30 dtstml j
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