Laserfiche WebLink
Please print or type.(Form dostgned(or use on elite(12-pitch)typewriter.) Form Approved.Ohil)No.2050.0039 <br /> UNIFORM RMRD01)5 1.Generator ID Number 2.Pago 1 of 3.Emergency Responso Phono ¢.8tanIfesl Trac 1nq lumber <br /> WASTE MANIFEST naO 1.15�1 JJ ( <br /> S.Geneators Name and ha <br /> maaing address) <br /> )IFFY LWi E N.2'--122 <br /> - <br /> �1Q0 E.KE(�1 LEWAN F'O. <br /> G0,1141101Phona 209 CA 515240 <br /> 7 r <br /> 8.Transporter i Company Name U.S.EPA 10 Number <br /> AC.'P,IIPV C —tr .-> <br /> 7.Trans er 2 Company Nam .S. PA ID Number <br /> 8.Oealgnated Fiici ty Name and$1@ Address U.S.EPA ID Number <br /> OK DIXON <br /> 7300 CHEVRON WAY <br /> Fora(, E fiona: CA 96620 }. '1 <br /> qa• %.U'S'OOT(lescdptionn(rlcludirg Proper Sfippng Name,Hazard G!ass,10 Number, 10.Con is <br /> Htsl and Packing Group(d airy)) 11.Total 14.Ural 13.Was!o Codes <br /> No. Type ouantiPf ti'ANaf. <br /> I. I <br /> ce NQN•RCRA HAZARDOUS WA TE.LIQUID (OILY WATCRI Q q 1 7P 20 t; ���. �.. ..... ..k <br /> 2J <br /> j <br /> 3. 66T 0 fil 204 <br /> ` DEPARTMENT <br /> ... .. .. ............. .... . <br /> f <br /> 14.Special Handing tnstrucCons acdAdd:t`onai to amat'on <br /> NAERGH 5P,,:!:I'll' PROFILE#JEil:DKI 0442 art PAURGENCY CONTACT:CREi' TREC:L-800-424-9200 t <br /> ADDITIONAL EPA CODES:901-,NONt: K APPROPRIA iF PFRSONAL PRUrECTIVE EQUIPMENT pt,(,�00'Z._ <br /> 15 GENERATOft'S(OFFEROR'S CERTIFICATION:I hereby declare Thal the contents of ft cons?gnment wolu511 and aceuraletp described obwv by the proper 4h!W*9 name,amara classfed,packaged, <br /> marked and(abdaplacarded,and are in el{respects In proper cortdton(or transport according to eppEceb!e tntematkmal and n6onal governmental regulat'ons.l(export Ah nwnl and I am the primary <br /> rparter•I ter6fy that dw con!ents of flus wnsgnment contain to the(ems of the allached EPAAdw.%iedgmaM oI ConsenL . <br /> I fy Ural the waste m'nl626on SVment fdenHYzd in 40GFR 262.27(a)(I I am a large avartRy go etor)or(b)main asmal(Qr)i 7' g ata)is m. <br /> e r 0 P ame Sg )'atUt Day Year <br /> r 16.latemsUona Sh:meals <br /> of en <br /> ❑import to U.S. ❑Ezpon tram U.S, Port try/ariL <br /> Transporter sgnaturo(tor oxpoitsc uy): Date tea tatg U.S.: <br /> 17.Transporter Acluwa!edgmenl of Rece'pt of Materials <br /> TranspoRer)Pi d>lyped Neme S:1� <br /> hlonUt Day Year <br /> 1A Lt ,#> I cls I t'!( <br /> z Trarigoftor 2 P&WyPed Name S.'gnatura Mondr Day Year <br /> a <br /> fY <br /> 18,Otscrepancy <br /> M.D'sueparuy l cation Space El Quantity ❑Type ❑Res duo ❑N u Re)ecixi s ❑Ful Re;e 6o. <br /> Manifest Reference Number: <br /> M.AlternatoFaO.q(or Genefalot) U.S.EPA ID Number <br /> U <br /> w Fac ays Phono: <br /> f$a.signatura,a(AfteinateFadityforGeneralor) htonbs Day Year <br /> 19.NazatdousWwa Report Ltanagamont Mathod Codes(La.,codos for hazatdous waste treatment,disposal,wW(eeyel!ng systems) _ <br /> d t. � 2. 3. 4• <br /> 20.DeslgnatedfadAyOmer orOperator GarSficaCorto(race'ptolhaiardauimatedalscare(edbylhamanitastampt nuedinItem183 <br /> PtiR' Name Sggnature j11 c Mon Day oar <br /> 0At'oiro9700.2?(Rev.3.66) Previous editlonsOro obsolelo, D(:SIGNATED FACILITY TO DESTINATION STATE:(IF REQU I D) <br />