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Please print or typo.(Form designed for use on Mb(12 ch)typswriter.) Form Approved.OMB No.2050-W39 <br /> UNiFORM HWRDOUS 1.Geieralor ID Number 2,Page 1 of 3.Emergency Response Phone 4. Tra qg fl b <br /> WASTE MANiFEST' CALOOD W I7 1 415.823.0772 !!77 <br /> 6749 ELE <br /> 5. Name and MAV Ades tors Addresu{if ererit than ma8atg address} <br /> OWtIMAL SVC RECYCLti>tG'Air Wiliam them omo <br /> S.Ef Ouraido,St. <br /> Stockton,CA <br /> Geflenr 's Phors: <br /> rampodari Awne 07EPAIDNumbr ' <br /> Won Paof6c UneS CO <br /> 7,Transpodei 2 Company Name U.S.EPA ID Number <br /> Designated a 'tgNameand N Armes U.S,EPA 10 Number <br /> ECCYtr.`'EStvkomentaf t1(C U422(3'i <br /> 111#v,Fest"Ifi .123 <br /> = FacWs Ptwna. <br /> '"51' Eta C>3rbon,Ur 84520 tSA <br /> ga. 9b,U.S.DOT Damoon( fig Prow Shipping Name,Hazard Gass,ID Number, 10.con taui xs ti.Total' 12.Unit 13.Waste Codas" <br /> HAA •. P O ('f Y)) No. Type Quantity WIJVoL <br /> x 1. 'nrianr rnr,a ie u r+ xa+anrr r+n ,n__nn�__ , sti ni.' X34 <br /> Orp - i"0141Ktrrtm HAZAR iO S HVPia r G,SOM tr�u -L'A r ra6wlatpui. . 'r :", • TLU <br /> . <br /> 2* <br /> w <br /> 4, s <br /> 14: pecZM HancOng� Ad¢•xfiond Idametkn <br /> t t . UG R€1f:XGUNG PRLX O HCl. <br /> WW PORWA6411.116 9= <br /> H09rR�tRA�ttr�ttf�t RBS)df18 �f��J 'y C��l «� <br /> 15. GENERATOR'SlOFFEMIrS CERTEATiON:I hareby daciare that the conte of this eoiaignment are fuly and acaua*dewibed above by the Proper stdpptng nacre,and am <br /> n and isbeWUplacarded,and are Ind respech in proper con ion for hanspurt according to sp$Wble InWna@ona!and nedonal gwommental tegilatbns.N export ditxnant and I am tha pft ry <br /> ExFatet i giifity tient tl>a cordents of tf�aonslgnmaN ariform.bo the temxs d ifs e0ediad FPAAdmowiedgmeM d Caised. '; <br /> I ce*#wt bia waste n iton statement ldantifxtd in 40 CFR 232.27(8)Qf t em a large gmr&y pnsra or(b)(1,1 am a sural quanff y generator)to tae: <br /> ' �C . /s• �Nraffypod Name r. <br /> 1�.irttema6 Shtprnents <br /> ❑impod I.kJ.s. ❑Eyw from U.S. ` Part d antrytad <br /> T for ex Dare U.S <br /> l 17.T tofRoe*of Materials <br /> ETransporter 1 ams epi <br /> Tnansportot2ftyte&Typed Nam .• rmwfe <br /> Year <br /> 10. -tt <br /> lea.:Dwapancytx�cationSp cc a Quantify ❑Type 0Residue PadialRafacbm ❑Fun Rejection <br /> l <br /> Manifest ReFmnoe Number. <br /> �. 160.Akamata f qty(a U.S.EPA fD Number <br /> f s Ptrars• <br /> 13c ignatured Aftmats FacRy(or erator) MmOx Day .Year <br /> 10.Humdoxs Waste Report Managemera Method Codes ps.,codesfor harmdom warns treatment,d4osal,and racyc&V aystatgs)- <br /> w 1 2' <br /> 20.Designated Fad2y Owner or Operator CesiNeadan,of of haw r mks covered by ft ms hest except as nobAln horn lea <br /> PrInWTyped Name <br /> th <br /> EPA Farm 87022(Rev.3-05)Previous editions are obsolete. ) DESIGNATED FACILITY TO,GEAfk T y <br /> is <br /> I <br />