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j 14:46 Marketing (FAX)323 264 2579 P.0011001 <br />• �t'lease print ar type.. , Farm Approved. C}M8 bVo. 2050.0039 <br />UNf Rm HAXAP� OUS is G sraEurid Number 2 Page 1 of 3, <br />3 � y Raspunsa Plgne 4. Aoffest Tracking Number <br />bN4SfEMAh19FE51 $4L ?�12 6 r,v r,:^tE d � 3 1 1953.2115 &°� <br />5, taansrztorsNameend MmbngAddress GOM14fCYs 9t§a,Address (ltd anal than Mailing address) <br />FkSNO TRUCK CENTER GBA DELTA `=R <br />IM E TRANSPORTATION <br />FRENCH CAMP, CA 95231 <br />GarevatarsPix 1H : V) CIS <br />6.1'eanscmrter t Company Hama � i9:S� EpAtb Number <br />mber <br />PACIFIC RESOURCE RECOVERY SERVICES ���✓�€�3�i <br />7, Trgnsperfer7:Comfanry Name US: EPA ft] Number <br />_. <br />H. dasigitatad Fac'tity Marne and Site Address RI.S VA Ib igtunEwr <br />PACIFIC RE!SOURCE RECOVERY SF.RVICJE5 <br />3150 EAST P C0 BLVD. <br />tOS r Nr,'EL s, Chi 9fti23 <br />Favi Phone: t$C?r✓y 7 i 'a <br />ga. 9b. u$. DOTihvmtptksn (fgdu,iV properS}JppingNorm,Hazard Gess, l0 Number, <br />1g. Curtanars 11. Tout 12,t!n f <br />HM am Packing Group (tanyll Na. Type L1t entity wuvi t, 1 ,Waste Godes <br />l <br />illy <br />ON <br />3)1N1325, WASTE #^LArMP1OLE SOU05(ORGANIC) <br />rN.01S. (ACETONE) 4.1, <br />DM l:it :' P 352 <br />8 � <br />C <br />1q. Speller Hatm6rig fnsbudrons and Additional Innomrafloa <br />t ? <br />9b2 j , AP# t7A_OO 9b3i AP 6334-9 � � <br />iuL€ VESE t�OeGLES & PROraC f ;i,V E CLOTHING , 4HR CN1FRGENGY CONTACT, KIRK WALOORF <br />--t) 111:11111 Of 11111 It'll I M 11111 <br />1S. GMPRATQR'3 UHROR'S CERTJRCATMi thereby declare that the wdonfsofft cauignelellf are MY and accuratofy do abrnie by M proper shpphtg name, ani aro classttied; paA4ed, <br />mxw and labeled/placard , and are n ad respects In proper common for transport accankng to applicable "emAd"wand national govemmeplai regular Ens. If impart shipment and I am the primary <br />EvGdor, I car{ ty ffiat the contents of ifs cm*nment ewvorm 16 dre leans of the abched EPAMmowledgmeot of consent <br />I cattily that the wasis ndnuniizek'a slafetnunfldan fisd in 4fr CFR 28?37(aj (f t am a targe quantity gewaim or (b) (dl am a smag quantity geriatawr) Is tw, <br />M*Ws Pmlud/Cyped Hamm lure R9nntia i1a) Year <br />r. <br />76 not ty , r Import <br />TranspmtersCgna(ure (Corexports only); o us. iJ Fvwf Cram U S f of efdiyleAll �. <br />Oatsl *lg U.S- <br />w p 17. Twtar'AckwtvladgmantofReteptaClAaieriats r <br />Trans 9'P6ntWRy i Karns 1 Sfgnawe f Monih Qaj Ye" <br />r <br />:TransporlerzrnrrnAIwo Norm ' <br />Month Day Year <br />w <br />t!3 lAs-pamy <br />iHa, i3isaepancy indican Space ��----tt <br />❑ Quanf ty ❑ Type !_ 1 Residue ❑ Partial RetecBon ❑ Pug Re <br />w. <br />monirssl Reference twuabor: <br />186 AtternatsF3rmiEy(or Genaraior) U.& EPA il) Number <br />Ya <br />si <br />Fasdvs Phone: <br />ScSgnafurantAllettmte'Faeisily(#fxrle?afae) httMCir pay YOV <br />18. Hata dmrs Waste <br />Re* Managernsn(PAsihod Codes (te.; odeslu <br />Cor hazardp rs wssto tra�tnsat dispas3t, a ti recy Cling syafomsl <br />PTA// <br />2r1. [5aa grated Fad S7wouror Opurator CattirxaUgn gf rip! of hazardous matetis}s wavered by the manifest except as rated �t u�n.16a <br />Printadf! S 5ionufute Btktt?Ht Oey Year <br />lZa, a� 411 <br />E'A Form 87n22 (Rev:1217} Praviovs editions a obsdets TRANSPORTERC PY <br />