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Please print or type. Form Approved, OMB No: 20500039 <br /> UNIFORM HAZARDOUS 1 : Generator ID Number 2. Page t of 3. Emergency Response Prions 14a Manifest Tracking umber <br /> WASTE MANIFEST CAL000286975 1 1 . 888 785-7225 012 2 8 5 0 0 3 E LE <br /> 5; Generator's Noma and MOFing Address Generatoes Site Address (if different than malting address) <br /> CALAMCO California Ammonia Co, California Ammonia Company (CALAMCO) <br /> 1776 W. Match Ln 2323 Port Road G <br /> Stockton, CA 95207 Stockton, CA 05203 <br /> GeneraMPs Phone: 0-� 7 <br /> 6. Transporter 1 Company Name U.S. EPA ID Number <br /> Advanced Chemical Transport Inc: / DBA ACTBNVIRO CAR000070540 <br /> 7, jransrptter2lort}RenyNome <br /> ry Y U.S. EPA IUNumCer <br /> Or Wi a Kecove S stem, Inc CAR000175422 <br /> 8, Designated Fadldy Name and Site Address U.S. EPA ID Number <br /> Yuma YES , LLG AZR000515924 <br /> 2730 E. 13th St <br /> Yuma, AZ 853015 <br /> FaaT 's Phone: 928-344.9828 <br /> ga 0b. U.S. DOT Doscription (indudirg Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 , Tots) 12. Unit 13, Waste Codes <br /> HM and Packing Group (it any)) No. Type Quantity WINOL <br /> 1Nori- MCRA hazardous Waste Solid , ( Oil filters) � )M 2 p 162 <br /> 0 <br /> w 2 <br /> CD <br /> 3, <br /> 4 . <br /> 14. SfeoaiHolding Instiud;onsaraAdditionall formation Project Number 170315 Document # D204999 <br /> 1 ) 176207 CAY'���~� 'S 46C �i <br /> kv <br /> 16. GENERATOR'SrOFFEROR'S CERTIFICATION: I hereby decinre that the writents of INS consitInment are fully and accurately described above by the proPer shipping name, aid are dassified, packaged, <br /> marked atxl labecdYplacatded, a1w are in as respects in proper conditiop for transport amording to applicable intemationatand national governmental regulations. If export stspment and I am tlx: Primary <br /> Exp iter, I ratify p>,at tne axtfehls of nils wrisigmnnnt confurm to the trumps of ate atlnched EPAAeknanfedgrtent of Consent <br /> i rf firth t the waste rrimmization statenwrnt x1onlified in 40 CFR 2e127(a) (if I am a large quantity generator hj CdI am a small quantity generator) is Ince. <br /> :16v <br /> e eratorsr0 f s Prfntedrryped Name S tins oro Month Day Year <br /> r 241 I <br /> in anal Sh�ments import to U.S. LJ Export from U.S• Port ofentry/exit: <br /> Transporter signature (foe exports only): Data )eovkg U.S.: <br /> CK 17. TranspefterAckmr+dedgment of Recelptof Materials <br /> Transporter 1 Printedfrypad Name S�nature Montn Day year <br /> O 116 71 <br /> C <br /> am v <br /> ra s Wild Pr yped Na S' Inauy ,. . Y' Matt Da / Y <br /> F- <br /> 1e• D saepancy <br /> tea. Discrepancy IrITIcalion Space quant ty ❑ Type U Residue ❑ Paw Rojoction ❑ Full Re;®dion <br /> Manifest Reference Number: <br /> 18b, Alternate Fac4dy (or Generator) U.S. ERA ID Numb®r <br /> J_ <br /> C Fadtit rs Pi a e: <br /> tOL i ^. Sigrrdhua 0iA%alnate Focli(y (or Gernaratur) Month Day Year <br /> rQ <br /> 19. Hazardous Waste Report ManaKjonent Method Codas Q.e, codes for tiazardous wale treatment, disposal, and recycling systems) <br /> 4 <br /> 20. Des ghaled Facility Owner or Operator: Coraticaton of receipt of hazardous materia;+ covered by the manifest e80e /s' n d in Item 188 Month Day ear <br /> nnl rTYRad (� SgnaVIVA, <br /> dr(J <br /> FACILITY Y 1 q CPA's e•MANI1=1rST SYSTEM <br /> EPA Form 870042 (Roy* 12&17) Piovious editions are obsolete4 t?I iSIGNATE?t� <br />