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please prim or type (rotfn designed for use on eche(12-pitch)typewriter.) - - - Form Approved.OMB No.2050-0039 . <br /> UNIFON HA7ANOM' 1.Generator tO Number _ �.Aage.fi3:of mergency Response Phone Trepung Number <br /> WICSTE'MANIFEST C`. A, 1 0 0 0 7 R n 7 r R 1 80[-424-9300 0160214,88 JJK <br /> 5.Generstc(s Name and Mailing address Generators Sh Address(N different than mailing address) <br /> Soft""We. Ssk"V Fuel#2707 <br /> 5918 III Road 6425 NPecpk:Ave <br /> Pleaoardw CA 94588 Stockton CA 95207 <br /> Gerwators Phone: y k 5 44 6 7 - 3 0 0 0 <br /> 8.Transporter 1 Company Nggrn& y U.S.EPA ID Number <br /> Enviomn"IMPL69"M,Inc. CAR 0 0 0 3 1 7 5 1 3 <br /> 7.Transport&2 Company Name . _ _. _. . __ ._- - -' --U. . roNumbaF .. <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> FWAr SQFVIM.lnc. <br /> MW MOMB Avenue <br /> BWWnk bn CA 92318 <br /> Fadutys Phorre:908 421-2012 ICAD98244448 1 <br /> gra; 94.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Comainere 11.Tuts) 12.Une 13,Waste Codes <br /> HM and'PacMnOXCUP VWY)) - No. Type Ouanlity WINd. <br /> 1E 176 So1dIE'Achill0ft Swirun W OgaM.n.ds.l9 MMfl.41, <br /> , <br /> 01* <br /> � I <br /> 3, _ <br /> It, Ell JER RECYCLING SERVICES'RIALTO FACILITYIEPA <br /> 4. if 1CAD9811.44461 HAS THE APPROPRIATE L <br /> r '• HIS WASTE AS SHIPPED <br /> 14. pedal me Instrudi a ane e8on 1)(S)CIBWDhkw Oars,III'IDNf,NOalas.Fuel emkioways- 11091417 ERC9#133 <br /> WW75493N <br /> "f I U - <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents oilhis consigimam are fillyandaaurarely described above by the proper shipping name,and as classified,packaged <br /> marked and labeled/placarded,and am in at respects In proper condition for transport according to applicable intemadwland national govemmentat regulations.If export shipment and I am the Primary <br /> Exporter,I cottiy that the contends of this consignment conform to the tame of the attached EPA Acknowledgment of Consent <br /> I caitiy that the waste minimization statement identlted N 40 CFR 25227m)(g I am a large quattgy generator)a(b)(NI am a small quantity generator)Is true, <br /> fir- <br /> Gem 61 sPdn"Typjil Name re Monro ay ear <br /> El import to us E)Exw iiia s 'Puloferdrylesdt . <br /> Z Transwda"r egnedIu (oreil5ti ts only(. - <br /> w 17;YreijspalerAdtrrdwleEgmem of Receipt qfMa - - - - <br /> ra.. 1PrimedlT - /; Mongro Day Year <br /> Q I ransponerg vmm I yipm Name - Sign— Month Day Year <br /> ix <br /> H <br /> r18.Discrepancy I�I <br /> 188.Discrepancy Indication Space ❑ Q"* ❑Type ❑Residue ❑Partial Rejadjon LJ Full Refection <br /> Manifest Reference Number. <br /> 186.Altamate FaUlity biC 'i-elatai _.. -' -- .� _ '•'^.: :-�R.`.= —�:r- _ .�„ US.EPA ID Nurser <br /> LL Facility's Plena: <br /> a c.Signature of Alternate Facility a nerator t Month Day Year <br /> 2 <br /> H19.Hazardars Waste Report Management Method Codes(IA.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> �P� PM1t20DognetedFa�lyOwner'dr ODereta'CeNMcaBon tltrecNptNtrezaNgs rtrcler(efs mtiered by tire, tarn "Ym'18a <br /> .C-. � alae r Y r <br /> �. <br /> Et Corm 8700-22(Rev,3-05) seditians ere obsolete. DESIGN — O FACI(..IW TG GEI EBATOR <br />