|
ase print cr:,pe iFonrn,desiped to ,Se f,,n e!!,. I I typ&qa�ter) Fc,,,f,;,,Appmved.OMB No,2050-0039
<br /> I -I ---- : — I , I -y P,�,Dnm-------—--
<br /> TZ stTrackinpiumber
<br /> tUNIFORM HA7JkRDFOUS" T�
<br /> WASTE MAN! ST C)'Or 0 0 9 5 9 9 6 i 'T' (900)4249-00 015481744 JJK
<br /> e!..ri.r—uvw, andr- I
<br /> t"7 0 City of Manteca
<br /> 100 1 lkest Center Sliect,Madeca-CA 95337 1077 N,4io Candird Drive,Martteca;CA 95337
<br /> '209) Greg Showerum
<br /> 4-56-8415 Atm.
<br /> NAT-�- FA M Num.-�u
<br /> R
<br /> J cac'Uy N,,,i,,aw Si.e Addfisz U'S.EPA 0 Num "r
<br /> Lmll
<br /> , C w, t okern Rwd,Buttonwillow,CA 93206 CA D 0 9 9 6 5 2 7 6 7
<br /> )"0
<br /> (661-1762-6200
<br /> I I T 1 1 dot I J%Mnm CLOC,;
<br /> T7-
<br /> 4.
<br /> NN0N-RCPjk Hazxdous Waste,goli&-,(LLad) 00 i DT 1 8 y
<br /> F
<br /> 65-Iom%� clean Harb�rs Pro&Nmuntm--r:C 14 1 3 1 2 3 0 7 B
<br /> Vegdation-0-5% Wear appropriate Personal Protective EQuipiment as mcessary
<br /> 77 GENERAT R S!OFFEROWS CERTiFlCATIOM f0ly aiv ,:eve iy r u;krnane,x.-(i oassifi�--,patkaged,
<br /> D5
<br /> 'md am the pnmay
<br /> an�xGll sn n ronj�lu,:,�of"'anspLfl otx�,,-�n�to
<br /> rtti'4 .f crfy Inal i� } P !"N's nSi-qr.f-,-m4 r ftmf—a f",ite. 0 Ccn's&,m,
<br /> "'FP�62 am i tWf.ay Of . qja�I�W, 11-11f,11"n"I 1�tnp
<br /> Mort Day Year
<br /> 6-1p behAf of tfw City ofklfwleca) 7*r— 1 1:�
<br /> i._..)
<br /> of et a
<br /> cf Year
<br /> Sin" loot, Dav 'fear
<br /> !M
<br /> Re dzon
<br /> --j
<br /> U'S,EPAO'Nofnbx.,
<br /> in ,5c,Si, NwnnapFnityGfneatw) tcFri Day year
<br /> -V-rg, �Iwnsl
<br /> 19—H,,,xdc--s VV;In:ket Mqn3gmnt kle!hrx!QCde-S
<br /> uj
<br /> ar Qpelatucef�5,�,w on Cf axpf 0 ,:h
<br /> ay oath ow yu r
<br /> P,'a 7C•.�2 2
<br /> il-C11"Y'T101 DES'TINA110N STATE OFF REQUIRED)
<br />
|