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Pleaso print or type.(Farm doslgnod for usa on elite(12-pitdi)typowriier.) Form Approved,OM8 No.2060.0039 <br /> UNIFORM HAZMR00US i.Generator ID dumber 2.Paye I o!1 3.Emergency Hesponso Prato d.Manifost Tracking)lumbo <br /> WASTi MANIFEST 0 A L 0 0 O i 8 2 6 4 E5 _ 1- (800)424-920 <br /> 5.Geller+It rWMi&a Ts Generators Site We"(if 0erent titan ma309 address) <br /> 600 E,KETTLEMAN RD. <br /> LODI CA 9t5240 <br /> Generators Rhone: 209$3"900 <br /> d.Transpatter 1 CompanyName U.S.EPAID#;urnter <br /> ASDURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 1.fransporler 2 Canpany Name U.S.EPA ID Number <br /> 8. Iy� oandSiteAddress U.S.EPA ID dumber3 VO C EVFZON WAY <br /> DIXON CA 95620 C A T O e 0 0 i 2 6 O 2 <br /> faa>:r sMm: (70T)693.6008 <br /> ga, Ob.U.S.DOT Description(induSng Proper Sh'p¢ng Natw,fiatatd Ctass,to NVnber, 10.Cn taiters 11.Tolat 12.Unit <br /> 111,1 and Packing Grasp(if anNa. Tyye Qvanbly y)) ,ItltVoi. 13.Waste Cedes <br /> cc <br /> 1. OlU 3 WAS TT -----T 225 <br /> .. '. <br /> i[ 2' Y <br /> Tr 06 <br /> ' <br /> 3. <br /> i <br /> HEALTH <br /> DEPARTMENT <br /> td.Spedai fiand5rrg ins(nicUans and Ali tonai In(annat'cut _..__ <br /> NAERG4 913 .:171 PROFILE N 991:DK1 .0442 *EMERCaENOY CONTACT:CNEMTREG I-SOG-424-9300 a <br /> ADDITIONAL EPA CODES :962:,NONE * APPROPRIATE PERSONAL PROTECTIVE EQUIPM9NY <br /> Talar *1013 <br /> IS. GC2fERATOR'S10Ff EkUR'S C[RTifICATI0IL I Ku bydeclare dial d;a cc feels of INS consgnnte.�l aro V;y and a<curaWy described abrva by the proper atipp:ng neuro,aTf are erassiF.ed,packaged. <br /> inatked and labated/placaffIM,and are In a4 respects in pt4 w coed l'n for Ila n$port acccYding to sppZcabo intematonaf and nai'orwl gowi mental ci gu+a!orf$.If export srrpmenl3W t aril Uio Primary <br /> Exporter,t cart;fy dut thoaa�tents eit}ds cansfgnment con!orm to rho temu of rho altact ed EPAAckrxra'. r;t3ent orConsem. <br /> I cartify That lite arasta nt!rvnt%zat'on 5!atarnant idon6Led to d0 CfR 2e2.?7{a)(.r I ant a largo quant;cy gero a)yr jb)jilt ani a sn*a!i gvant� gonaratar}s wa. <br /> Generator'sY,feceisPfinteCypedNamsS,eat t3 i MonUl Gay Year <br /> G-i'lu-1KA -e-� I.. - 1oz1.wL1Y. <br /> —j IG.Intema6ronaiS109ni013 <br /> rt la U.S. EY{ n fra3t U.S. Pnn of enUyrexit_ <br /> ❑Impo <br /> -- Transporter s�nalure(forexpals onh# Data leaving U.S.: <br /> 17.TransporterAcknav:edgmentof Rete pi of tdate,•iais <br /> Tfansporser 1 Priniedliyped Namo Sgnalura 11 1 t.?ontit Day Year <br /> Q Transf.,cNter2Pdnied/fypedNamo SOwture Month Oxy Veal <br /> i8.Disctep:.rcy <br /> tBa.Uiscrepaneyfnd:catlonSpaca ( y <br /> LJ Ueantity ❑Typo ❑flesdua �_ Pari+aiRc;c'on Fu'tRe,ocGen <br /> 1.4ar�teslRe(etenceh'umber. _ <br /> 18b.Aternate Factity(Df Genera?ar) U.S.EPA IU Number <br /> ca <br /> U- Fabt:ly'sMona: <br /> Lu W.SgnaluwofNtefnateFa0ly(orGenera;a) tranut oay Year <br /> 2 <br /> u� <br /> 10,kamrdous Wzclo Rejx l rtanagnrnent L!oitwd Codon(i.a.,cedes for hazardous waste Leatirwl,d'sposai,aril rev,'rjrg Sysierns) TT <br /> � J. 4. <br /> Ca <br /> 20.D0S1gn31FaairyO,ilwr Cperata:CeOu C�Onnorrece:ptatna Srndl0al3�01,ereobythsrtwtiestexceptasra' in He'llIta <br /> P16rie[UCyped N2ttte � � 02y Y <br /> g <br /> bamh_ G� J 1 <br /> EPAFofm97M22(Rov.3 5) Pr8vi0uSediti I It obsoielg. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />