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<br /> 1 . Genamh5r ID Number M'
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<br /> �n 1 of 3. I rnergenc¢• Rnsponse Phone 4, Manifest Tr c ing Number�/ � � ;715•:71 �7�i7 (�
<br /> n Address 1 15 `� 11402J6JD mallingaddress)
<br /> Genaalor s Phone;
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<br /> 0. Transpoddr 1 Cpmpnny Nome
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<br /> l.S• EPA IDNumhar
<br /> R440S r_if��rRtFNi4ENipd, 1LR1A1:: yy 9Altr. t',.+sDC1 #d 5�a` - _ �
<br /> 7, 7ransporier 'l Cernpany Narnz k • U.S. EPA ID Number
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<br /> 8. i)estgnalediaatdyNante and SiloAddrass Y � .----__�__u__. . �_T� _ ___.�_�____ ,�. _ _ r�v� • � � �.�._. -�,•! •,e,_
<br /> hZAJA E %Y%/iR�' 1*0E:ITfA4. 8FER'VIC1 S lid, U.S, FPA ID Number
<br /> 1515 S:Olftl-I RIVER RD,
<br /> Isf.f74i! tr, i5;;�
<br /> 1All 51 S, CKlih;)EftRO , CA SSii 'i
<br /> 015x71 .57 47
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<br /> ga, 66, U,S. OT Desc OW) ONION Proper Shipping Name, Hazard Class, ID Number, I10 Coniahters 11. "total 12. Unit
<br /> HM and Packing Group (itany)) _ 134 Vlasic Codes
<br /> t No. Typo Ouamlly WtNol,
<br /> 0 1 ' NGn RCRA HAZARDOUS WASTE LIQUID (USED OIL) — - 221
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<br /> 14
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<br /> 41
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<br /> •f4, SpadalHandthglnsbucUonsnndAddilionallnformalion
<br /> EIR LISEP OIL, WED OIL ERC'tr 171 : t 1 � eo rc7ll
<br /> . F2. CONTRACTOR: RWOS EMARON�ENTAL SERVICES
<br /> r q 1 tANMEfRS TO BE TRAINED AND USE P.1�PROVED PPE;
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<br /> Ise GEN6RA701t SiQ � (tOR'S CERTIFiCATtON: i hereby dedare Utel the contents of this consignmentare !oily and accurately described above by the proper shipping name, and are dassirted, pabkagod,
<br /> markedand(abelpolp carded, anderetneUrespectslaplaperwndi8onforhaospodaccordlpgloappgcabiainloma0ppalandnational governmental regulatons, Ifexport shlpmentand Iamthe Pdreary
<br /> Exporter, l ceiltythat the oontenls of lhls consignn>ent conform to iha terms of the attached EPAAcknovtedgmant of Consent.
<br /> i ceruy that th6 wasio mfn(mizaUon statement }denUted In 49 CFR 282,27(a) QI I am a large quan8ry generator) or ( 1 am a small quanU enerat Is true.
<br /> GeneDay
<br /> alor'sfOfferoPsPdnledRypQdjdame Stgnat ;r
<br /> " �5 �t wctr vett sr
<br /> r .r 18• IntemaUonal Shtpmonls ..
<br /> Fee ❑ Import to U,S•, Export from U : > Pori of entryloxi
<br /> ? Ttanspodersignaluta (toIfexportsonly): Da[eleevngU, r '
<br /> 17, TranspoiterAckrtoMgmeni of Rece}pl of Matedals40. be
<br /> Transporter 1 Pit ledlryped meId + Signature Month pa Year
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<br /> r , l�astatdteirencri•Number.FaOi ly (or Generator) ; :g r, ; :?:
<br /> J ; d< <, • : ::tr.; U.S, EPAIDNumber
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<br /> Facililys Phone, , •� .; 1 y ', ; '
<br /> W 1k Signature ofAllemaleFaciliy (or Generator) s ax, * c 4 INVrk `,
<br /> Ise: r. a 1 i�!i.r ,} '4W4,
<br /> Month Day' year ,
<br /> uIs
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<br /> sweet 4. e4 "
<br /> 19. Hazardods Wasto Report Management Method Codes (i.e., codes for hazardous wasto treatment, disposal, ;
<br /> n i • 1j 2. 1 30 °iY • ,Y 4,
<br /> 48 44
<br /> 20, Dosigrialed Facilly Od'nor or Operator, Cefilkallon of receipt of hazardous materials covered by the manitast except O noted in Item 184
<br /> Prfnledmpad Name �// Signature }fonUt ,gOay eat
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<br /> EPAFor 870 •22 (Rev. 3.05) Previoug"edillorWard obsolete. DE ' rGJilATED PAClL TQ DE5TINATIp(V S7AT� 1�
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