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<br />,17 � ?(71, 1-77) 1 U It b I tj IN A I t 17 F Flt I U (i I U L AA s c - TO A N P f i ill 'U' T E, M)
<br />UNIFORM HAZARDOUS
<br />1 1, Gene ales 10 Number
<br />CAL00121,393929
<br />2. Page of
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<br />ifost Tracking Number
<br />WASTE MANIFEST
<br />1006777986
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<br />Ge 5 NV8 and Mailing Address jerieralors Site Address (if different than Mailing address)
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<br />6 , , 11fornia at
<br />57,TOCKTON CA 95*120fY._.0,0117?
<br />Generator 5 Pnove: 21Ti9-.3 -.3 3 8 P. 5 6
<br />rt" U.S. EPA 10 Number
<br />7 TranSoorter 2 Coro Dany Na -le U.S. EPA 0 Number
<br />�PN IFHAR'RORS ENVIRONMENTAL SVC Tf,,JC�
<br />8. Designated Facility Name and Site Address EC -11 U.S. EPA ID Number
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<br />9b U S DOT Description (iriciudr4 Proper, Shipping Name. Hazard Gass: ID Number,
<br />10. Containers
<br />1 11. Total
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<br />12. Unit
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<br />and Packing Group fffanyi)
<br />I Quantity
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<br />11 Waste Codes
<br />No.
<br />Type
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<br />Handling Insilructions and Additional Information T' c;j) —.
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<br />1.760—CH/W 'TF I Cnqtr.Ar�t retq I ri%?ej rY g r-flerall o
<br />pri initial transpcwtpr tp idd nr -Jbstitklt� addi—zo,,a, F
<br />7 GENERATOR'&DFFEROR'S CERTIFICATM; I hereby declare that the contents of this =*ignment are fullyarx!accurately described above by the proper shipping name and are class+fied. packaged,
<br />marked and labehiidfplacarded, and are in all respects in proper condition for transport according to applicable intentationai and national governmental regulations, it e I shipment and I am the Primary
<br />Exporter. I Ce" that the contents of this consignment conform to the terms of Me attached EPA AckrKrMedgjn,,,nl of Con
<br />I certify that the waste minimization statement iderifified 40 CFR 26217(a) (41 am a large quantity genera 's true
<br />Genwalw'stWemrs Pin, d Name Month Day Year
<br />—Merfry
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<br />J import to U.S EW from U.S. r?rt
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<br />Tranisfxxler sionature i for export.� Dni� Date ieavin,
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<br />17 Trans;iorter Acknowledgment of Receipt of Materials
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<br />T., Vier I P in Name
<br />yPed Month Day Year
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<br />'Gransar (Name Sqnati rs Mont), Day Year
<br />18, Dirrepa,,cy
<br />I b C-aepancy lnddcalron Space [j Quantity EJ Type F-1 Residue L I Partial Rejecso, Fj Full Rejeclion
<br />Manifest Refererc* Number
<br />ft, Alternate Facility (or Generator)
<br />U.S. EPA 10 Number
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<br />tic. Signature of Allemate Facility (or Generator) Month Day Year
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<br />oortMaragemen! Method Codesiii�e codes for hazando
<br />19 jv.ardous1Wast(,, Re os waste "atment, disposal, and recycling systems!
<br />gim(ginall �da,014ty
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<br />2:o, d Ow,141111',Xeratof. Cerbf-caltion of tempt of haze 4smaterials covered by line maritlest excep?, as noteo In Ram Ise
<br />PqritedfTypo Name
<br />1 '.,7 7 7 77-1
<br />,17 � ?(71, 1-77) 1 U It b I tj IN A I t 17 F Flt I U (i I U L AA s c - TO A N P f i ill 'U' T E, M)
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