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prim or type. Form AppmveU,OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1.Generale ID Numbar 2 Page 1 d 3.Em ,ai flespwua Plq e L ManNM ireeFi Xunlbr <br /> WASTE MANIFEST CAD043274M 1 916371$747 019f74131 J J K <br /> 5.Gaibai Name aM Mi AM. &mraMs Ste A&MA,Ail different than matliy aMreu) <br /> TERESI TRUCKPIG MIC. <br /> 9a0'*T&Ksif'/0 F. ✓i a fox AgoRli <br /> LODI,CA gi <br /> Generetda Peon '2916 <br /> 6 TranAxW1 Company Name U.S.EPAIDNumber <br /> RAAkiS EWRONMIENTAL SERVICES A1C. CAOW40035515 <br /> i.Twsi 21 Name U3.EPAIO NIm6m <br /> B.Daynamb Fml6h Name aM Sle AMrex RAMOS EMIRON0.ENiAL SERVICES NIC. U.S.EPAIDNumbw CAD74100-M <br /> 1515 SOUTH Rft-ER R0. <br /> WEST SACRAMENTO,CA 95691 <br /> FaaiiNs Pbme'Milli <br /> ya, 9b.U 5,DOT Dai iplion(,dWllg Pio., n.ppin9 No,HaadN a. ID Numbee10 Conwi 11.Tow 121 13.Wute CN2a <br /> HM AMPaak'nyG p(1-y)) Na. T, f:A.* WIJWI. <br /> t. s wy s <br /> (Oft., 1 P am <br /> dor yy L) <br /> W <br /> 3. <br /> 14 <br /> 11 vFt <br /> 3 HarAI IreWctvina aMPilbiAonal ldwmaton /) B law ERGBv\I'1 /` `J_' <br /> HA CONTRACTOR WAMOSEN.SiOV U. FAI `�v /�r� <br /> HAPiC NT ACTORI!� OS ElED A:� I15E ,ApPRCY:cD PPE .l '7 <br /> 15. OEXERATORSOFFEROR'S CEWIFICARON: I bereby declare Mat the mnai of His awsgnmenl are My And aavrilaly Cesnibell above i m proper snWpmg name,am aa tlaslf'Iae,paA AM, <br /> makM an01Me'MIpMmNM.aMare in 511 mpecm in pmpermkNw brtranspon acmNing to apgicabb inlemaoonalantl national goremmental regula0oralf expM sbipmentanE I am 9ie Primary <br /> E�Meo I reNh Mattlre cvmm�b dtMs mrsgnment mnbrm W th tarns dMe atUCNM EPAPNnavMtlgmenlol Conant. <br /> I cetity Mal Mewmae mmimlaatim sNement ioentifiM In aO CFR M2.2i(al illemamrye puanVhyerersbr)or(b)(' am asmNl gcmtirygeretd«)mwe. <br /> Gmnmml'YOMmds PMleWfypN Name "mMa Monts Day Year <br /> 16.IntemaAonN Nlpmenm ❑ImpTtb OS. ❑Eapwli U.S. PMdenhylevit <br /> F <br /> ? irensmner vgnaNre(M e.pommN): Oam leann9 U5.: <br /> W 17.iranspwhrPbmMeEynantdResigdMeb®m <br /> TiamspoRet 1 Pinmali Name Sgnalurej Y <br /> y r <br /> I. <br /> a2 Ttamsppner2PM1eNTMANaM / ( S'. Month Day Year <br /> C <br /> i10.DAcrepan,' <br /> lb Otsaepmay1MAAbMSPS ❑ omety ❑Type 1-1 Rai ❑Patl9 Rgrwtion L1 fid ReiMOM <br /> MAAMM Ilefemxa NullAx'. <br /> 13b.Almmem FatlNh(or Gnlratnr) U.S.EPA ID Ni <br /> J <br /> U <br /> tai Favii Pbpne. <br /> w 1&.SignabredNtemam faofh(a GenereW) Monts Day Year <br /> a <br /> a <br /> H19.HazvYus Wum ReporlMenagement MetNM tma(I,e..mbeaM NamhAnwasm Veeblrent Nismsal,aM rerydinp sYMarul <br /> A.OexgnaRtl Fa ih O'M�arwOperatw.CerAFratlan of rM*of WoM3 amai omini by Me manttut exaptu Metl in lmm lib <br /> 11 RinbQRypW N3rt si Monts Dry Year <br /> EPAFotm 871(Rev.12-til PmAoue etalons ara obsolete. GENERATOR'S INITIAL COPY <br />