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Please Prins or . Foml dosrgned for use on o ite f2-itch Vpowdlerj ForntApproved.OMB No.2050-0039.. <br /> UNIFQIihi HATARDOU8 }Centel ID�tytr�bat Page t of 3.Emergency R@sponae Phone d Ma lfest(Trrackm Number r) �j <br /> WASTE A9ANIFEST CAL 0 U $ 6 :4 b �$tJq� 2d;93Q0 0 0 9 5 1 6 G'3 JJ K <br /> s Gena ress OatetworsS100ress(Ef"aontMan=AVQaddtess) <br /> WD E.KETTLEM4N RD. <br /> Li}Dl OA 95240 <br /> Genoatota Pharte: 209 339-M <br /> 8,Ttanspottar i Company Nams U.B.Ef'A!D Ntrmbo-t <br /> ASBURY ENVIRONNENTAL SERVICE=S C A.V 0;,2 0 2 7 7 0 3 6 <br /> 7,Transporter 2 Company Noma V.S.EPA iD Number.. <br /> 8.04SIQ ilUTAVNam83nd$itBAddtdSS U.S EPA ID NOW <br /> 730000 HEVRON.WAYDIXON CA 9624 <br /> Paa7i s Phone: <br /> (70716M" CAT0H00 2 602 <br /> 9a. 8b.U.S.DOT Dwa"m Wudvtg Proper Sfdpp-%Marne,Hiazard Crass,ID Nwaber, t0.Comte mats if.Mel V.Unit f3.V45sta Ccdas <br /> Nbt and Paddm Cxorp Cd any)) fio. Typo 4uamiy Wilifol. <br /> go NON-RORA t-tAZARDOUS WASTE,LIQUID(OILY WATER) <br /> 001 T T G <br /> C+`3 2 <br /> Fit <br /> t, <br /> 3 , <br /> a. <br /> DEPARTMENT <br /> fa.sptxfatH trutn,eoortsanortdd+trdnaltnam+a �-� <br /> NAE 901: 171 'PROMF-498i :DKi 10442'i:ly ROENOY CONTAOT:OHEM REC 1-9M-424-9,� *ADDITIONAL EPA <br /> CODES:913t :,NONE'APPROPRIATE PERSONAL PROTEOTIVE EQUIPMENT <br /> 15. OENERATOR'StOFFEROWOCERTIFICATION;IhaobydociateVial the omientsoftwso stgrenentarofurtyandacwtetelydasc;bedabovebyawixoperstdpftname,arderadasstbed,padeged. <br /> ma*ed and fsbeloof.ecatded,and aro to se tospecis inproper eorxi tion for transport uwdW to app6wbto tntoma%Wind national got'otnmetttat regufaw.If eW ship Wt3nd I am the Primary <br /> Exports;,l aunt;/shat Uw Contents of this oonsignmemt oonfontt to the tormsof the etadted EPAAdasaifedgmentof CWWAL <br /> i aut'ty that Ute waslo rrt'n4tpzatia�statement iden�'.ed to d0 CFR 2b2.27taj(d t am 8 ktaa 4uagGty 9onetata)o;(b)Cot am a Small gtwntiy gorse 8tot)is truo. <br /> Conatus s1DrTatotePr4tlartRygadNarna ;...5}8natyid rh Day ear <br /> J✓" __� <br /> .r 18.intema tdpntents <br /> ❑Import to U.S. ❑Euport from U.S. Pat o(on*rdt: <br /> Transportetsignature(fooxpatsoNy): Oatelea-figU.S.: <br /> 17.Tfdmpodei AdW.+WVNnt of R004t of).talari* <br /> ionlht Day Year <br /> Transporter i PrinteaTyped Nama Signature e}{ { <br /> Trarkspodet 2 Ptintedfl}^ped Name _ $iQnatU[0 MUM Day Yaw <br /> f$.Djs�;apartcy • <br /> Iaa.DtsaepancyindkabonSpacs QU9A44y � o ❑Reew. 4Partlal,Rejecuon ❑FARojacoen <br /> tda9e31 Reference Humber <br /> 10.AlletnateFuOty(a6enocata) US EPAiDNutnba <br /> 4z - <br /> +d Faatiiyis Ptwno: morgh Day ear . <br /> � Sea Slpnaiur6.otAi[emate FaaTry tiN Generator) <br /> d . <br /> 19.Hazardous v/alto Report hianagement 6tethod Codas Q.o.,codes for hazardous waste treatment,dispasar,and r�rg SW-Is) - <br /> 3, 4. <br /> Ll2o.D4natad faa1y Otnnet Of Opurarar.G rtiPption of recetpr ori hazardats materrafs waved by tho merdfasi mopt es Nod In Item i8a <br /> tart — 3lgnaNro FiAnth @at <br /> I' f o& /Z <br /> 'rPAForm8700)22(Roy.3 �5,-fevioussaraobsofete. nrefr_ iA'rc nt,lt irvTn 11PATMATinm ATATF IIF R1=t3t]IREC)1 <br />