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PleaSe print or type,(Farm ccs! ned for use an efte 12-0ta) evvdter-) fon'Mpfpved.OMB Np.2050-0038 . <br /> t) IFORM}IlFZARDO, $ t:GaneralolDNumbef' 2.Paggg'1 a; � 4:Ma.1relrt gp�furfi r <br /> IF6W IAHIFEfiT_ CAt?q a� 53 I. 1 s "T1 0. ¢ �( <br /> WASTE - 011 <br /> 5.CtonarWaHarreandMafdngAddress ars§raWsSite Addness(If�dtNerentdsanrnal8npaddresa) <br /> CFai pis 1r�1 :ap 10- Lodi <br /> Cal-Trans SfWr <br /> � 3 B At 84!n E hyi4e St <br /> Genemlw's pfiana: -' ; �i^fir ' 3 wd <br /> u.5:E umber <br /> 7.Trarts der2CompanyName <br /> U,5,.EPA!i7Nummbaer <br /> g,i0esfgnated FealSp(Nam;and Site AddrM SAF� -.KL Y aT.E�1'a", '1 h1{r, U.S.EPA3il f ltontsar <br /> 6000 88TH-PREET <br /> . �►I�i�38�°-4.99. .. f~f��Qtltl���1:a4't <br /> FacTfys phone: <br /> $ ttb.U.S.ta(T descrlpltcn{uidu¢Irtg Proper 3hlpping Name,Hazard Class,ID Number, iQ.Conla;iers. i1.TQ*l Q Uni 13.Warts Codea <br /> HM and PaGWrig Group Cd ahyl) Nb. T a Qumtty WtNol <br /> 1. 1104-^ CRA �lF�Zi4�i:[?AU WASTE, LIQU C1� !aLU <br /> 2. MON—MA F 4ZAR€OUS WASTE, 1410VID CN(AQUUlJ$ PARTS. WOKE, MUTION) <br /> i 1'34 <br /> f 4,spa I Hane�n9 n�tnrcuons a,�axidi4onaf lnf«ma n S GA .52;Ovsr�,vq GA��i7„on t�i t`” s:Z:r` <br /> ,�4 't-MI lE; G I>yl�_FD'Ri By DE <br /> ,0-800-46fl-1,1160 t Sii �' TFx-) <br /> 15. GENEMTOR'SPQFFEROR'S CERTIFICAT(ON: I herehy declare ftmt the mnlents of ltiia,corlstgru:teot are scdt <br /> "ind a:xnreteiy deed above by the Ower-shipping name,and ere dasalfie6,padagm. <br /> marked and leha{adlptaceMed,aqd are Li Wl respects h,proper catxift fortmnspc iaccarding to applicable ln*rtalfanbland nahcnal governmerm reguletkns,if eipodihlprrw and I am 0%Pftwr+ <br /> FApo:ter,'1:orak14tihrtcantents of this cbaslgnmant conform to the tenor of the atlached EPAAcknKWetlynrent of conserd. <br /> I certify that be waste mhiimlzaHan s}alamen_t WenlifedIn 40 CFR282.27(a){Ifl am 3large quantityyganaratnr)or @)i a small-quardily gene aux)s true-_ <br /> lq s reespPrinl ypedNlar�re "Month Day Year <br /> .�r Is.Intema Shipments ti <br /> Impcn to u.5.,, ❑bwt tlam U.B.. Rcl+l or.ealryfetdl <br /> Transporter s�natdle{far axpans aclyl Data leaving U.S.: - <br /> �- 17.`Ran"AdamWe%r!wntofReca'ptolMotwwa <br /> Tire. or PrWidflp Name- Signa Mon Day Year <br /> 96 Ede, � <br /> 7 n oder 2 F ted yped Name S?geatura ,. Month Day Year <br /> V.Diseffil-y <br /> 18a.lyscrapancy indicaticn Space Quantity ❑Type ❑Raaldua ❑Pertlel Rdntlon ❑Fu0 Rejection <br /> M.ardfesrRafar 'Number. <br /> 18b.AltamaW FOOty(01 Generotor) U.S..EPAID Number <br /> a <br /> w Fadi s Pharr <br /> Iac.5fgnalumofxteraate fadty(or.Ganeltor) Pntii flay Year <br /> rdoueyfaateltapollMghgemaraWlhodCodes(.e.,codesiorhexardapawssl treaimerit.dtsposat�andfecycungsystems) <br /> _ 4 <br /> 20.Des!gnated F Owner or Operator:C aoon cf mcatpt of hazardous materals eeuered by ata manifest except as need to hem t Be <br /> Pdnts ll�ped g� Mon bov eat r <br /> EPA Form 8700-22(Rey,3:05, Prev,ous adttions are o$ade e. flES1C NA'fEb FACILITY TO G!SNERATOR <br />