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Uin Vflru—I <br /> See Insiructions ort back of page 6 text x�usrurK os purr iu r"V <br /> I pro r: if o type roan destined for use on elfe(U prich typo—Oaf) � Saclornento CoWornro <br /> UNIFORM HAZARDOUS1 Gerwralor'US EPA ID No MonMe�D— ant fJo 2 Pope 1 Infonrnarbnh the shodedorora <br /> WASTEt I I f I ! 1I I I 1 II I of Yrnlre{q��uuedbyFeAderdlvy <br /> J GenwafoyI Fame c d Moanp Address Can teen SerV].r'E r A Slate Montest Documbnl"be'91592962 J 15 �✓��6 2 <br /> 1 1500 Shaw, R , Stockton, CA 95215E farla ^e'�oe' <br /> A Gerwrdoys Ph1Ofe f 910 466-2709 1 t I I r I t 1 t <br /> 5 tnarsrportorICompany 1, r A us EPA0Number C SIalelfvrnporlelllD <br /> PTS Envlro Tlnental Service Cl AI DI 9181 21 01 4 r 0 1 2 IOi 6 D IronspodlorsPhw" 91.6 652 -553.5 <br /> 7 Transporter 7 Compary Nome r D 115 EPA ID Numbef'l 1 -? E State Tron+porlees ID '7 <br /> r''�6/1 F.�J�P.�,-r ter( rLi-- G t 1 r �I.�cl `71°/ I 1' 1 / ! F turns +orsPs,u,o - e..(�� � w .7�• } <br />} 9 Dosiprgiad roc9ty Norco orsd sdo Address w Lb EPA ID Number G Side Fodlltt/s ID <br /> FmMyI <br /> Refinery Services l+ P DI 01 81 31 1 61 61 7t�i 8 <br /> nd <br /> 13331 N. Flighway 33, I At 1 1 A t I 1 1 A,1 1 r l <br /> 3 12 Conlakan 13 Told 14 Unit <br /> t I t Obfl3estcrpTias twx_ IrV operr SnS>PkV a Ilo[o ci Clam and rD Number) No 1 1 "Not L Wade"Unt91 <br />� a <br /> Stole ' <br /> G Fuel petroleum oils-nos Combustible Liquids 2 ' <br /> � Fell <br /> C E n in fj VF 1G None <br /> Nb Side <br /> E <br /> R <br /> r A I I 1 1 t I I <br /> T c store { <br /> 0 <br /> R EPA/othet <br /> 1 I I 1 f I I <br /> d _,J V State <br /> 7 1 A"lond Dofedplsars la 1.rSalerah Listed Above K 1lorciing Codec for Waiias Wed Above <br /> 1-1 Fuel oils with unaatexmioed aMoont of halogens �' � b <br /> 1-2 Waste Water <br />' 15 Spoclol rlondlwV 1min_Ctpra and Adddrond lrlorrnalan r � (� ` f <br /> Capital 'rank Service IO� _ CAUA q+A� `�11 <br /> i 2518 B & C Alley <br /> Sacramento, CA 95816 'uu cJ- <br /> IG GEN{RAloR3 CERnfICAT10H I hereby dacb+e ilial the conlenis of This eonsgmnoni ae fury and accuratoly doscrrbod above by proper shrppfng name and are elauirred � <br /> poked marked and k7Geled and ore in all respocis n proper conddron for frompod by hghwdy occordav io opp"ble htarrx7honol and rotronat govemmenl requtalbnt <br /> K I our a large awnldy parxfrgio, I caddy Ihot 1 hcNn o p,ograrn n pkxe to reduce the volume and Ioxrcdy of waste raneralod to the degree I have doleenined to be <br /> ocoramicary pr(r_14cobte and It�al 1 have selected the pmcicobto rnolhod of Imalnnanl storage or d"id cunenity avolabb to me whlch nvnrmaet the present and fulure <br /> !Isnot to hrrmn f ru3Hh cxsd tlrn nnvronvnont Of? Y 1 am a small ouonldy gonorator t have made o good fodh effort to rrwrvm¢o my woite gonardion and calecl the best waste <br /> rnonogomonl method Ifx'Y!a avolobso to me ad Neal 1 con nriofd <br /> l Prnied/Typod Nome Sgnoture Month Calf Year <br /> 'KAA, 9,1 ISI i <br />' t 17 lrartporior 1 Acknowlodgemenl of Receipt of Moreroh <br /> l Q Pfrlfed/fy me Sgnalsre <br /> Month Only year <br /> i <br /> A <br />. S <br /> t P <br /> O 18 4ompoder 2 Acknowie emenl of%ceipt of Motonals <br /> r R PMW/Iypod Name Sgnatsre Montt Dal' year <br /> i <br /> 01� ��I� <br /> F 19 tJncro IndrealoDspace for q;IL7FI1 To 76 r� r �UfeA SIf44-17f trAG 1/X 6Z <br /> A U I <br /> C <br /> t <br /> I 20 FoCldy Owner oh pperatof ConVKx)rron of roCerp)of IxiZcxdous malernh covofed by IIM manifest except as Doled n dorn 19 <br /> Purled/!ypod Noma Sgnolure Month Oat' Yeo, <br /> �7 Ale I <br /> DO NOT ITE BELOW?F{I NE <br /> Kis 6022A(I 2M) Wfr19 T5DF S[NDS 1WI5 COPY 10 DI-15 VJIMEM 30 DAYS <br /> rA 8700-22 To p 0 Box 3000 Sacramento CA 95812 ` <br />