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Please print ortype . Form Appreved . OMB No . 205D0039 <br /> UNIFORM <br /> WASTE HAZARDOUS <br /> 1 emVST CAR 000 2Pagelof 3 . EgMgRRe&TIPMpe ° M020595 ' 16 JJK ' <br /> 5 . Genemmm NameandMaili Aaaress Genc1to es�S/ita♦Pil�a1ressss3 (Sf dpoerentMannuflagoddresal <br /> 2808 COLINTR�' CLU L 2808 COUNTRY CLUB BLVD <br /> ATTN : ICC RECEIVING <br /> STOCKTON , CA 95204 STOCKTON , CA 952D4 <br /> Genmloes Plmne : (209 ) 461 -5555 <br /> 6 . TmnspoMr l Company Name - U . S. EPAIDNumber <br /> EQ INDUSTRIAL SERVICES 69K 435 642 742 <br /> TTrenslrmler2 Company Name V . S . EPAIDNumher <br /> � D Roac INc . DBA T ATCO R S c '( Mo4orT1 a ore ssa <br /> e . Doedii LL9 FaanyNameabdsireccaress US ECOLOGY IDAHO , INC . U . S . EPAIDNan <br /> 20900 LER9 - EY ROAD IDD 073114 654 <br /> GRAND VIEW, ID 83624 <br /> Fa0ii Phone : 600 2744516 <br /> ga . 9eU . S . DOTOescAptbn ( Inducing ProperSNpplrg Name , Harard Class , IDNuMer, 10 . fgmahem 11 . ToW 12 . UniI 13mohae Cedes <br /> HM ab parxin9c (adny)) No . Type Duanliy WWDL <br /> 0 X t + UNI950 , WasteAtmuh , 2 . 1 ( DGTSP 11286) , ERG #126 001 DF 00031 P MCI Di33 <br /> z X 2 RQe . , Waste FD� mTpm4le BQW& , ri (Acetone , 001 DF 00021 P DWI D01 D <br /> , 3 , 11 , ( RQ ; D018) , FRG #128 <br /> 0002 U154 Uj <br /> X 3 . UN a Corrosive OgUid , basic. agarga0ie, mos . DD1 OF DOM P D0C2 122 <br /> (So ' nH eo Polassbrm Hy*adde ), 83 PGII , ERG #15 <br /> X 4L <br /> to UN <br /> --. e e Sa >FAcwo 8 , PGIL (RQ ; W8 DF 00287 P D002 141 <br /> ER FA <br /> ta . ' alHanaurg lrrsW mne naAsalbo al me � na6 <br /> \RA14 V 1 - 2 \ UWH ) S 3 . AB9i\1014A' BSIRtW - CORROSIVE BASIC <br /> 4 . A& 9h5R I ' Di - fill : of fr 4m <br /> (o () ggq <br /> 15. GENERATOR' ERO SC FIC PD : I embya ermfen Dae sgmn nt Mamaraaalelyaeaolbea � o5ythe properslvppug wn , aNaretlazsifiM , paekag [d , <br /> matrtMud MbN aA a8 ! far N albWara raP Aos' a MgWa ' . U had! shop win Ne PanarY <br /> Ex N Ne to of Nis g btm r10 Ne P nt sent <br /> I mIN ' state a Ne ifietll FR26 ] ( lamasm 11 Ru yge rotor) blru . <br /> Ge Ae 011e a Monty Day Year <br /> 09 17 19 <br /> 1 al hip ❑ I bU . S . frwn LLS . Palofe lexit : <br /> mnspbtus naWmMexpob Y Date leaJm9 U . S _ <br /> W 17 . Tanspo Atlmvxledgment RexeV of <br /> W Tmnspoaer PMkdllye Name Signature Month Day Year <br /> g Evers � - 1 091 171 19 <br /> 2 TenrdeNlype IN bee Month DaY Year <br /> i G - r - 3 lP <br /> ~ 18bixep ry <br /> a . Disaeparw,y 1M1 lSpace ❑ china ❑ Type [] Residue ❑ PaNal Relecti0n ❑ Full Relecuen <br /> Man falReferems Number <br /> 18b . Altemete Fetility (or Genema) U . S . EPAIDNumber <br /> uQ- FmilysRme : <br /> a, 18c . SignaNmofAllemate Faciliy (or Genembr) In ON Year <br /> 19 . HaaaNwS Waste Regal Maragenno Me otl Coda Q . e . , wtlesbWavaon waste beaTmtaispozal , ondneycli systems) <br /> 1 . z . 3 . <br /> H141 H141 H132 H132 <br /> 211 . Dxsgw aFalily Omwror OpereNr QhhhczOon ofrecei havMws ma@da6mmreabythemang Med 'mlbml8a <br /> PMtO Name✓ / ^ Sgna y <br /> ar <br /> EPAForm S70422 ( Rev . 12wq Pre viousedifionsam Gbs0lete . DESIGNATED FACILITY T ' s e - MA FEST YSTEM <br />