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f <br /> O S A V <br /> PIt' se print or type.{Farm designed far use on elite(12-pitch)typewriter.} Form Approved.OMB No.2050.0039 <br /> UNIFORM o t pa,(Fo HAZARDOUS 1.Generalor ID Number 2.Page 1.of 3.Emergency Response Phono 4.Manifest TrackingNumberf. <br /> WASTE MANIFEST C A L O�}0 3 3 0 4 2 3 1 (800)424-9300 �1 6' [ ! 41�-3 JJ R !> <br /> 5.Generators Name and Mailin Address Generator's Site Address(if different than mailing address) <br /> TRACY CHE�lRail ET-Q& INC <br /> 3400 AUTQ,PLAZA,WAY <br /> TRACY,• CA 95304 � V <br /> -Z9 8354500 <br /> Geonralors Phone: r <br /> 6.Transporter 1 Company Name U.S.EPA iD Number r <br /> AS13URY ENVIRONMENTAL•SE=RVICES C A D O 2.8 2 7 7 0 3 6 <br /> 7.Transpoa er 2 Company Name U.S.EPA ID Number <br /> 8,Designafed Fadfity Name and Site Address U,S.EPA ID Number ` <br /> 'DEMENNO/KERDOON Ir <br /> 2000 N.ALAMEDA STREET <br /> COMP ON CA 90222 CAT 0 8 0 013 3 5 2 <br /> Facility's Phone: 131 V;3 <br /> 9a, 9b,U.S.DOT Description(including Proper Shipping Name,hazard Gass,ID Number, 10.Con(ainers11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity W#.Not. <br /> v 1. 11N 993,WASTE FLAMMABLE LIQUID, N.O.S.,(GASOL(NE, DIESEL),3, Doan 10038 343 <br /> PG 11 <br /> DM G <br /> ua <br /> 2, <br /> uI <br /> CD <br /> 3. <br /> 4, <br /> 14.Special Handling instructions and Additional ln,ormation <br /> EMERGENCY CONTACT:CHEMTREC 1-800-4249300 NAERG#9BI;x.28 *PROFILE#981:366974 GASOLINE,DIESEL <br /> APPROPRIATE PERSONAL:PROTECTIVE EQUIPMENT <br /> 15, GENERATOR'STOFFEROR'S CERTIFICATION: t hereby declare that the contents of this consigarm of are turfy and accurately described above by the proper shipping name,and are dassi€ed,packaged, ' <br /> marked and labeled/placarded,a`pd are in all respects in proper condition for transport according to applicable intemationatand national governmental regulations.If export shipment and I ars the Pdmary <br /> Exporter,I certify that the contents of chis consignment conform to the termd of the attached EPAAcknowledgment of Consent. #. ; <br /> I certify that the waste minimizao statement identified in 40 CFR 262.27(a)(if I am a large quantity e i am a small quan enerator)is true. <br /> [0J nn aloTsTO A ype a •g use M9 ntha'y�J. Year <br /> ,_-1 16.Intemational Shipments <br /> T-- ❑Impart to U.S. ❑Export fmm Port of entrylexlt: <br /> .Transpnder signature(for experts only): Date leaving U.S.: <br /> Lu. <br /> V.TransporterAcknovrledgment of Receipt of Materials <br /> Trar}Spoiter. i Pri ledd ped Name Signature Month Day Yeas <br /> Transporter2 P in a yped Name Signature Mouth Day Year <br /> 18,Discrepancy,. <br /> 186.t]iscrerancy tndlcalion Space ❑ Quenttty ❑Type ❑Residue ❑Partial Rejection Ll Full Rejection <br /> r <br /> ,;, Manifest Reference Number. <br /> lab.Allemate Facility(or Generator) U.S.EPA ID Number <br /> FacRiVs Phone: Month Day Year f <br /> 186.Signature ofAllemale Faeillty"(or Generator) <br /> �„ vF <br /> 3A;=' <br /> S2 19.Hazardous Waafe Report(Management Method Codes(Le.,codes for hazardous waste treatment disposal,and recycling systems) <br /> 1. rs• 2• 3. 4. <br /> ca <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest a pt a n Item 18a <br /> Priniedfryped ame Signatu oih t>a Year Y <br /> � s <br /> EPA Fomr 870022(Rev.3-05) Preyiobg editions are absolete. DESIGN D FACILI7 Y TO DESTINATION STATE(IF:R QUIREb) <br /> ) <br />