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Please print or type. (Form designed for use on elite (12-oitfemter.l -2D3 Fmmn AnornV H nRAR Nn 9nan1 No EPA Form 6i (Rev. ;coo) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response one II. _. _ _. _.__ .._. ____ 4. ManifestTracking Number WASTE MANIFEST CADo0g18s06s z 800.535.50$3 002 0 42993 FLE 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) Wiled Aerospace Strudure Applied Aerospace Structure D.D. Box 6189 3437 So. Airpon Way tocktan CAZD8_ Generators phone: 94W3339 Stockton, CA 95206 . mnspoder i ompany Name U.S. EPA ID Number eneral Envhonmental Management, Inc. CA0983849880 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number GEM Rancho Cordova, LLC 1855 White Rock RoadFacility's 1Rancho Cud 0 N-1 ves Phone: CAD 183 9a 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit HM and Packing Group (if any)) Quantity Wt./Vol. 13. Waste Codes No. Type Waste Paint retailed malWal, 3, 001) 0 o / DM ass� P F003 F005 w N1325 Waste Flammable solids, organic, n.o.s., 4.1, c� I (Methyl Ethyl Ketone, Acetone) M 'q 2, 362 D035 �b I P F003 A/ P— X Q UN3066 Waste Paint , 8, III (ethanolamine, romium (0007) d / 6F (—% 343 D 007 P 14. Special Handling Instructions and Additional Information 91b1l) R0738 ERG: 128 (1 x5y) 9b2) R1918 ERG: 133 (-�, x55) 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. Generato M ems Printed/Typed Name t riatu Monthay ear L4;4 K. VxvN� kvAw tv 1407 r— 16. International Shipments ,. ❑Importto U.S. ❑Exportfrom U.S. Port /exit: Transporter signature for exports only): Date leaving U.S: W 17. Transporter Acknowledgment of Receipt of Materials C T porter 1 PnntedrrypedN Signal r on ay Year Ka r �/ I a 2sponer2Pnnted yped a e Sgnaiure 7 on Day car d I— } 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Alternate Facility(or Generator) U.S. EPA ID Number J V Q LL Facility's Phone: w 18c. Signature of Alternate Facility (or Generator) Month Day Year Q 2 y19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) p 1. 2. 20. Designated Facility Owner or Operator: Certification of receipt of hazadous materials covered by the manifest except as noted in Item 18a 1 Printed/Typed Name Signature Month Day year EPA Form 6i (Rev. ;coo) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)