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Please print or tw .(Form designed for use on elite(12-pitch)typewriter.) CJ 1529534 APP.C tlotce 1,070T,19-2 Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1. 10 Number 2 Page 1 or 3.Emergency Reaponas Phor» 4.W-R NM Tracytlng m <br /> WASTE MANIFEST C A L 0 0 0 2 0 2 7 � s 2 f.6�()�462-37113 J J K <br /> 5. neralot'�Nanb a A.ddresa Generabfs Site Address(1 dWomil Inan mailklg address) <br /> aroet -� <br /> 2375'N Keteran Lane <br /> Lodi.C_-A X16242 <br /> Generat&$Phone: 209 35.9.9374 ATTN•Reversp 1_orns?)o5 Prec.essa. <br /> ii.Transporter 1 Company Now U.S.EPA ID Number <br /> C!ean Harbors Env Serrices Ino MAD 0 3 7 3 2 2 2 3 0 <br /> 7,Trxwporw 2 Company Name U.S.EPA ID Nw" <br /> 8.p arkad�FaV Narpp and 1Sile Ad U.S.EPA ID Number <br /> l �Fd+'H??IArS-3n 95? <br /> 1024r^om fEssa Road C A u U 5 9 <br /> San Joco A 9513$ <br /> U <br /> F s Phow - X4081 441.0902 <br /> ga. 9b.U.S.DOT DerAption(induding Proper Stopping Name,Hazard 0twm,ID Number, 10-CarAanrs 1I.T0131 12.Un8 <br /> HM and Parking GfwjP[f arry)) Hm � Quo* WtNbL 13.WaaN.Codaa <br /> 1 V A1S-rE AEROSOLS,2A.LIKI 1950PONE-L Itd!!TE-n OI.IA11_M'!TY 343 D001 <br /> zTOX!G JG7!J.+.DS,O!?GAaJ!G:!`!:CT:G rpT�STiC!nE I:TIr2ul.14T 343 <br /> K GiBR0MiDE).8A.U.�i2810,PG it 00 1 E)T 0 0 0 3 0P•. <br /> WA ST'E.14YPOCHLORrrE SOLD?ONS,8,UN1781,PG 11 <br /> )' 131 . 0002 <br /> 901 <br /> 4.kAT4ST>r COPC�C-SIVE UQUID,ACIDIG,ORGANIC:N.O.S.(CITRIC <br /> K A1-1D),8,UN32265,PG.1-1 �! 0 1. D F 0 0 0 0 a P 0002 343 <br /> 1. Irobu,,uma end Ammons intorwn <br /> LP O <br /> LcrRdQM92. LCCRC 1 x1SDP rna3. LCCR19 r 1x50P. <br /> VVOVCJ1629534 FLEET#f442106 LPOTARGE70-21 4. LCCRC 1k50P <br /> 15. OR'$CERTIFICATION: I hereby dedore that the conlerrts of thio oonslgnrtw t an fuly and <br /> marked and labeladlptacadad,and are h all respects In pmW w1dWon la banspoo tthacccd b arab d-Abed above by Im p opr 9hlpphg name,aril re dasS14d,Packaged, <br /> kW appgcaHa ammadonal and nabonal govamrnental eguiations.11 expel afr pmeM and I am the Prkrary <br /> Expo ter,I aNy a1.t the mntsnt,d Wa caugnnarnt carltum b me fames f1f a»aCaclyd EPA Ac&POU dgmaM of Consent <br /> I ce*slat the wash m nk*&don statement Id,,kW in 40 CFR 282.Z7(a){d I am a lem�e <br /> G *0ftMe3 P' yped Name II 1Nr>a 1 ar(b)(i l am a smaN quantity{>anrabrl is Inn,� Monts Day Year <br /> -� <br /> 115.1010 hiprrgnla ❑Import to U.S. f 7 <br /> sign <br /> Tran6pu ter ature(for exports only): ❑F 1 S. Port of enbylerdt <br /> Lu <br /> 17.TronrpormrA6cwwtadgmeol of Rlrcelpt of Afatermk Dam Iea Ing U.S.: <br /> o� Tranepofbr 1 PA*&TYpad Name <br /> 4 Sf±an Sbit2pr Signature <br /> rn Mondr Def' Ywr <br /> nnwder 2 PdnmdTypad Name SOW9 p 0 8 07 <br /> Moth ay Yea, <br /> 18.Discrepancy <br /> 18a.Disnapancy indlcafion Space ❑ ❑Type <br /> ❑Res due ❑Pa,tlel ReierAlon ❑Full Re)ecbon <br /> 18b.Akemate Fadbly(rg Genarabr) MaNlest Refa once Number <br /> U.S' .EPA Ip Number i <br /> Y Fadlry's Ptwne: <br /> 18c.Signature dAharnate FeSlity(or Generator) <br /> Month Day year <br /> 19.H�tniyae Wata•Rapph Merwge+Want Mefhpd COCon(1.e.,catlw!w�gVoua waam inatmenc aKp�y end <br /> �5 t. 2. /DGyri'71g 3yS18R16� <br /> 3. <br /> 20.a 4. <br /> s+grlafed Fa, fi'Owner or Opratcr Ctrlidce6ar of receipt of <br /> �nnPPed No haza dos matadals covered <br /> by ave rnarVraet a riled in hem tea <br /> A," <br /> ear nth aY e <br /> t-yeaa!`�or has the�aorOote efe nb-volete. `1415 /X� <br /> P rrrYxs or and L�ilf aocrot tfia•wavco•z+JP1� <br /> q'rf T41 7T4 k1nT IH?Jti,4?4YI I--qt;)NHI :UIO A-r PC':QT PMP;:)-FAT-:J H <br />