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u) N O m <br /> O CD vi <br /> Z O j <br /> I <br /> U) ?, 4 <br /> m K o <br /> MCD <br /> 70 - ___— ,ved pfAB No 2066-- I V CD <br /> Z •.5 a <br /> 111 . GBF i <br /> M <br /> Please pent - r�+• QJ <br /> UNIFORN 1 800.2553824 <br /> Generalnfs 5da address(d tlirtarent than maulag addrassj -1 <br /> WASTE tsAN1FFST Vi <br /> S.Geneatofs Naris sad Maunypdimss west Lane CMvtvn r-F CDt SIDW <br /> 4747 Weetlarse <br /> 20�99�1735 Stockton,CA 95210 O <br /> U-S.EPA lD Number CAROD0300548 X- <br /> 6eie pe Pham' <br /> • 6Treasewta'1 Cangany Nemo Independence Environmerrtal Services,LLC u.S.EPA ID Number O <br /> � 7 <br /> r Twsemw 2 CarnparY Name - I••1 0 <br /> • U.S.FPA ID NlYnher t I <br /> tfyT330010000 t I D <br /> B.Dasgrhatedraaily Narneand Sl6A&soS1 US Ecology NV,me 0 <br /> j j k PO Box 578,Hwy 95,11 MI 5 13eaHy CIO <br /> . 775-553.72113 Scatty.NR/89603 <br /> FaW�ys Rs+ne� 10.CO3W,ers 11.retail 12.Urd 13.Waris Codes <br /> ga.a s.DOTDmaefAnt^fiadutlk g p p&SWng Name,Hawrd Gess.IDNumaer, Q�n <br /> No- TVPe Ii7 WLNoI. <br /> and Padang GraiP OfanY11 e--F <br /> HM P D001 D01B 331 CD <br /> o� X 1 UN1993 Waste FMammal Liquid,mcl.s.,3,PGR(Waste G8119aina) 2 y� <br /> tJ • O <br /> . D <br /> i w C2 � <br /> r�1 ' (ail <br /> r� q <br /> 14.Special FeMung InsWcnons antl AtltliGwal Infwnatian '--1 <br /> ERGO 28 1=55 � <br /> ER ConbactR M15'9833011 <br /> 15. GENERATOR.SIOFFERORS CENt7FICATION:I hereby amlam liked the cdntwis MIs consignment are fully and accurately describedabae by the proper shipping name,and are classified.packaged. (¢D <br /> •¢ narked and IabeMlaeardA,and are in an respects In aoW condition far transport aoowding to applicable international and national gommmenlal hegulafcre.If export shpal and 1 am he PI"nary , <br /> FxPe1I I oernly teal the ewlenla of this consignment conform to the tenor of the ahachad EPA <br /> Acknowletlgmwt of Consent. <br /> d i I�rMy that Ina waste 1111=11 sheleme t identified W 40 LFR 262.27(a)(if I am a large quart Willuser)or(b)(iff am a small quantity gerhelatorl is Irue- <br /> . GeremroVsiONemis PmtleNTypddNerne Sgnatum Month pay. Year Ii <br /> CD <br /> 16.In IBlnaner1915fdlmenla 2 , n <br /> F ❑Imponfo U.S. ❑ERport hortl U.S. Purl Menhylexil', CD <br /> . = T TWpodi signature fror eRporls only(. Uale leaving U,S.7 M <br /> W 17.Tmnpyatar IofR IofMetwiaLs l+, <br /> Tmnsywter i P ypotl Name I�• <br /> rp Signature Man <br /> t I <br /> • i Trznspate P cetlffyped Nam Yea <br /> algnatu <br /> IB Disaepanq Month Day Yw , <br /> • 1 Ida.Distmeal Infest.Spaca ❑Quantity ❑Type <br /> P f r Il ❑Residue Partial Rejectm <br /> ❑FWk Rel , <br /> IBb Atemale Fardlity fw 0eneralor) Mani}est Reference Number. <br /> II CD <br /> rJ <br /> ti U.S.EPA ID Number , <br /> Farildya Phane: �. <br /> 1&.SgnaWreofAttemate Facility jor Genamlar} CD <br /> z CD <br /> y19.Na ardour Wazle ReMonl� pgy <br /> . o l purl Management Mdined Codes(i.0-codes for heuendous waste IreaLnenl, year o <br /> disposal,and re �--1 <br /> cycing systems) -0 Z) <br /> s (71 <br /> q_ p (D <br /> 20,Designaletl Facility Uaner oro � (7 <br /> Pml yped Name Aerator CertificationofreWpi of hazarbeus marodals k`g O <br /> covemd h v Q <br /> y Iha manlfestexeept as Holed in Ilam 1Ra <br /> EPA F Signature <br /> orm 870622(R,,12-17)Previous editions are obsolyfe, 0 <br /> Mant1 Day Year r � c <br /> DESICaNATED FACILITY TO EPA s e,MANIFEST U) o <br /> MANIFEST SYSTEM C N <br /> CA) <br /> N <br /> co � <br /> CD W <br /> O <br /> 00 <br />