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Plaase print or ape (Form designed for use on elite(12-pitdt 'ler.) Form Appmed,OMB No 2050a39 <br /> UNIFORM HAZARDOUS 1 GeneratorlD Number 2.Pape�3E$-m— <br /> I y Response Phone 1. st Tracking umbar <br /> WASTE MANIFEST CAL W79 �t17 Iit3$ ti7� JJ K <br /> S.Generators Name and MailingAddrees ItsMdm5(if different than MOV address) <br /> A O CVJ.ADA SMARM 8 FtIVA!X93 1 E LGE?I AVENUE <br /> k.Ot3�WES, CA 80051 LODI,CA 95240 <br /> Generated Phoma. i fs► c 4 o <br /> a Transporter 1 Company Name - U.S.EPA ID Number <br /> 7,Transporter 2 Company Name U . A Nrmber <br /> WD RUCK INC,QM�TCO . , ff <br /> B.Designated FaCOy Name and SitsAddiess U.S.EPA 10 Number <br /> Us ECOLOGY IDAHO,INC- DO 073 114 654 <br /> —10409 LEMLEY ROAD <br /> -,,RAND')AEW.ID 83&24 <br /> Faciwty+s Phare: <br /> ga. 11b.U.S.OOT DesaWon Crag Pm"Stripping Name,Hazard Class.10 Number, all.Censalners 111.r.TOW1 � 13.Waste Codes <br /> HM and Pdd*Group(if any)) No. Type <br /> c X 1UNIM,VbW*AW*Soh.2.1 (DOT-SP tiZN).ERG111129 001 DF 00009 P <br /> X 2UAi3M,Mkrde Corrosive fid,basic.iirtoWmc, n as 001 DF 0¢008 P � <br /> (Sosfh=1#)i waft,PetaSdUM HV&01W),S.PGIi.ERG#154 <br /> X bN 1"1,V&SW HWadift0b.,Soi>t M.S. PG 11,ERG#154 001 DF 00012 P D= a� <br /> �1tl 41CRAHazia *W V*Mv.UqW(COFMWM Produdg) 002 DF 000$7 P <br /> 14. I}tarrdfaq Instructions and A,tldldonal information <br /> I SFHM1 I STHV41 AEROSr)lS 2 SFHVO4 I SFHVO4-i-ORRO�AVE B UtAkOS SrXWS 3 SFHIIVM I SFhV4M-M-EACH 4 <br /> •u H SP111CLEANUPMr3,OR>BANTS 4 SFNHMI!SFHHMI-NON-HAZARDiAIS LfWIDS&SOUDS IT 14.1970445171 <br /> 15. GENERATOR'SIGFFEROR'S CERTIFICATION:1 hereby dachn that the=terds of tiffs cansi rMN are fully and acorn*drnsaibed above by the poo stri*g name,and are dzs W.padraged, <br /> marked and fabelad7placaNad,and are in al respects in paper condition for banspod amordag to appAuhta 4tema50rW and natbrrel ptmmmantal mgtbtiom.N export sldMwa end 1 am Ove Primary <br /> Exporter I certify that the contends of this con*nmant conform to the temp of the attadred EPAAdamw%dpment of Conseil <br /> I certify that the waste minimization stalement idenged in<e CFR 262.27(x)(A I am a targe quantity penerator)or(b)(41 am a arae)quantity genermor)is true. <br /> GeneretorslDllemrs PrgiWaypaad Na/me gnature On Behalf of SMART&FINAL STORES LII Year <br /> l � 4-4 ) 4 �-T — --- � (0 is 19 <br /> i Mtemationat -vMO's' ❑Inrrport t,U ❑Export ion L'.S~ Port of eraylext <br /> -- Transporter sgnahae(for-Ports orjV) Dote Waving U.S.: <br /> 17 Transporter A*awkipmeM of Rece4A of Materials <br /> TranspC+I4<1 ypedlyar)+e - Si oo Day 17? Pal <br /> E)S i8 '�18YGar <br /> 4- talc" <br /> z2 Norma Month Day Year <br /> 18.Discrepancy r <br /> lea.Discrepancy Indeatlon Space ❑ Quantity ❑Typr ❑Residue ❑Penial R*dfar ❑FA Rejection <br /> Mardest Reference Number. <br /> lab A temata Fit aty(or Generator) US EPA ID Number <br /> U <br /> Tai Fadtitys Phone Nblr>h Day Year <br /> 0 Sc SouturdofAkemateFaokty(aGenerakxl <br /> a <br /> x <br /> T9.Hazardars Waste Report Management Method Cafes(I a.,=ies for harardous waste beabrrertl d'ssposal,and recyr7ng systems) <br /> 1 2 3 4. <br /> r•4-24 H132 I H132 H132 <br /> 20 0asignated Faffq Owner or Operator Certif"bw of receipt or hazardous materials covered by the manifest except as nded in item 18a <br /> yW Name 1 oay Year <br /> EPA Form 870D-22(Rev.3-05) Ptevrous editions are obsolete. DESIGNATED FkCILITY TO GENERATOR <br />