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2041 Navy Dr, Stockton Record ID PR0521437 <br /> 11/26/2018 Hazardous Waste <br /> Photo 26: Oil/water separator tank disposal record_(pg_ of 2). <br /> Form Approved-OMB No.205M039 <br /> PleasEpun%06vbifumdealgnedi0luseon4te(J2-pikch)lypnwdlei,} 2PagelCI 3,Emergency Response Phone 4.ManiFeslTracking Number <br /> 1.Generator lO Number ,,..:- - - JJK <br /> T lYN1F0RMHA2ARUM <br /> 4r WASTEMAN4FEST � 11 Generatot55ite AGdress lif d"Aferenl than malling address) <br /> 5 Ge,nr 1..;..w;e,a:;oaA4aiGlgtlkdG�� 0. �J 11'�� <br /> v�')"j <br /> X11 -4 j 11 JGl1✓y 1:, <br /> t, ,•� Genelar-Cps Al <br /> Phone'. ' U,S.EPA I�Number <br /> e Transpuner 1 CcmWj Name <br /> LLSEPA ID Number <br /> T Trauspmtw2Campany Name <br /> E.Designated Fadlitg Name antl Si@ Address LLS EPA 4D Number eJ <br /> Fad .a Phone' "' <br /> ga. sb.US.DOT DBBdllpdan(induding Proper Shipping Neme,Hazard Class,ID Number, 10.eonlaipers 11.Total 12 Unit 13.Waste Gad- <br /> HIM erd P.6i,g orcup Ib anNII No. Type Daanaty Wt Nal_ - _ <br /> a <br /> a <br /> Fu <br /> w <br /> co <br /> 3. <br /> q. <br /> - , 11 Fpe.lal Mandl'mg lnsL dlons antl Add,Mr tlnlor,,,i)n <br /> 15 GENERATfIarsm ERMsCERTITICLTION;I lyrebydec19R1!kIE conlenranffhu[ SimmBMa2 Nlly antl escurately dls bM above by rhe proper 5hPRID name-orb are rlesslhetl,pdChk" <br /> mahetl¢Mlebvletllplawrded,arA mem all respecla in proper cerWifidn Ior Vdpepad acourdingto�nptorahI.intemaucnelantlnational governmental ieg*Wns.If.,I shlpmeniantl am1Nv Primary <br /> ExFoaer-I cenifYlha[me CanlanRa€Nis wnsignmenl conlmm tolna Isnns 011he aVlached EPAArkuwledgmM!MConsent <br /> 1 Leahy mel the waste mWmlzvtionalammenr ldemiW rip CFR 202.21(s)(il lama large quwMY 9enerelo0 or(b)lir lamdSmall qus"yg­4,1- _ <br /> SlgrraWre _ Month Gay Year <br /> Ge�eralorypgeruts PrinleNTypge Nam¢ / r•' t <br /> f ! , <br /> - <br /> 16.rrvemaWnyl Sryy,nenls �r <br /> i LJlmponw LL.S, IJ Erportfiom V.S. Ponof <br /> o¢nUylS. <br /> — uanspeners�gnawniw`eawnammp: Dale lea.�aq s.: <br /> ' � r.,�p�mpc.,wn,eM1w`�m�ldneeetrdorrmmnms <br /> T-`anzPmlarS PMdetlRyped lame $gnalure Mento OaY Year <br /> 4 Trar;ponmePnMadTVP�Neme Sigraw,e om tley ea <br /> } 1s nlunoancy I�I <br /> }{4 18o 0isue—,mavauensgx �pvan,iry ❑typo ❑Rezitlax ❑partial Relzctbn LJ FuII A,-- <br /> -i-R— <br /> el--Mani-Ret —Nu— <br /> 1Pk AMmvlo Fv<IIM Iw Gmrew�rl V.S.FFA ID Number <br /> FrnfM1y*P <br /> Val <br /> rW..iy,ep:n of AaxnMn F'a[illry lo* >rrun Numn ^rY to - <br /> 1a Hnui6�1n v2w RnPonVAonapomeniMNwa[;yvs lle.rweslo,nazzNouz aazle,ruaunenl,alslwsel,endnq�yzyslemzl - <br /> '{ ]I1❑ruymeJerx'uYGxneiwOperaYx(:aala�fpnonal m-mp1 n1 rntl aylM1 n mamas oq�alnlrpm la• <br /> Il Flo m n inn uaY <br /> r( <br /> EPA Fpr'tlFp0.311Rrcr}a5Y Proriuv.aCmune ma obnelely. ❑MGNATED FACILITY TO GENERATOR <br /> John Alaniz, REHS Page 26 of 29 <br />