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�Ti� r-}-0275 0.733 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) 1 Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS I 1.Generalor ID Num er2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST 7 6 1 0 . 1 002963547 J J K <br /> 5.Generator's Name and Mailing Address G6nerat6es Site Address(d di erenl than mailing address) <br /> DEPT.PARKS&RECREATIO -CARNIGER C�,t.C1h,S) {7- esu.�mc.�F c6-ya.ttsQcc,-r rn-ca y-�,C,Tw,n 6\hcC , <br /> 16600 CARROL HOLLOW RD. . <br /> Generator's Phone: TRACY CA 95376 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> nI � C A D 0 2 8 2 7 7 0 3 6 <br /> T.Transporter mpany Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> DENENNO/KERDOON <br /> 2000 N.ALANEDA STREET <br /> CONPTON CA 90222 c A T o 8 0 0 1 3 3 5 2 <br /> Facility's Phone: <br /> ga. 9b.U.S.DOT Description(including Proper S ping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity WWaI. <br /> 1. p <br /> K ` . /Unoia 343 <br /> O y^ _ .: <br /> RQ,WASTE FLANNABLE LIQ ID,N.O.S., (GASOLINE),3,LJNM9 ,.; ,,D Iv1 G <br /> w <br /> Z 2. <br /> w <br /> C7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> NAERG#981 : 128'PROFILE#981 :269710 50107 GASOLINE/DIESEL°PO#At10082367'APPROPRIATE PERSONAL <br /> PROTECTIVE EQUIPMENT ; <br /> 30 -0 7— — <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:Thereby declare that the contents of this consignment are fusty and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br /> I certify that the waste minimization statement iden"fled in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Genera rs/Offerors Pnnted/T d Name Signa Month Day Year <br /> 16.lntema'onaf5 ipments <br /> Z ❑Import to U.S Exporl from U.S. Port of entry/exit: <br /> Transporter signature(for exports onty): Date leaving U.S.: <br /> ce- 17.Transporter Acknowledgment of Receipt of Materials <br /> o~C Transporter 1 Pp.WWyped Name Signature Month Day Year <br /> O G p <br /> CL <br /> z Transporter 2 P&dedfryped Nafne Signatu Month Day ear <br /> Q <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Full Rejection <br /> ❑ Quantity Type 1:1 Residue ❑Partial Rejection 1 <br /> Manifest Reference Number <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> v <br /> Facility's Phone: <br /> W 18c Signature ofAltemate Facility(or Generator) ,. month Day Year <br /> Q <br /> Z <br /> U) <br /> 19.Haze us Wasta Report Man menl Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1.— -�Yu�Kl 2. 3. 4. <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pr v yped Name S gra ` Month Day Year <br /> E Form t706-22(Rev.3-05J Wevic7usedi ns are obsolete. DESIGNAT FACILITYTO DESTINATION STATE(IF REQUIRED) <br /> 10143.0936 <br />