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Please print or".(Forth designed for use on elite(12-pitch)typewdec) FormApproved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1,Generator 0 Number 2.Page l of 3.Emergency ResDoase Phone /.Manifest Tracking Number I pp ppi�t(( <br /> WASTE MANIFEST CALOOG269375 J. JJK <br /> 677-737-5277 012218250 <br /> iGe al a me MaiF. dere Generators Site Address((different men mail'aa�gg address) <br /> Ya.ncJ'a"1�1ka�`� -'9�oc�`cton 3927 Clark Drive Atte: Doug Grose' <br /> 3927 Clark Drive Stockton, CA 99205 <br /> Stockton, CA 95205 <br /> Generators Pnore:gIn Tan-iganII-_ <br /> 6,Transporter 1 Company Name LLS.EPA ID Nomad, I <br /> I <br /> Worldwide Recovery Systelas, Inc. CAR000175422 <br /> 7,Transporter 2 Company Name U.S.EPA ID Number I <br /> Hesitant Empress, Inc. HJD986607380 <br /> fl D�gcla Facley Name aM Site Access ,s w+NA I..{T _µ'y `�- U.S.EPA ID Number <br /> 1007 Vulcan Road-Haskell 1�1�9�Fro°��� FJV1:—NT <br /> Benton, AR 72015 Q'= A' <br /> Fadetys Phare:800-377-4692 ARD9810578(70 <br /> ga 9b.U.S.DOT Description(induding Proper Shipprg Name Harard Gass,ID Numter, 10.Containers 11.Total 12.Una 13!Washe Codes <br /> far am Packing Gdap(daa9)) No. Type Quantity YrtNM, <br /> z g 1 (Petrol= Distillates, Mineral)Spirits) „ 3, P <br /> PGII / M V <br /> z z <br /> ,W�g emcee+dinq 1 L capacity) , <br /> 2-1, DH1950 DF 'ZS P FLI(I--- <br /> 3 <br /> I <br /> T <br /> � <br /> 14,$penal HaM'u Inswctlons aiWM61ia1M lMpimalion - <br /> 1) 128; 1010-13429 2) &001—l ia)1-\yyS0 <br /> 0111 to Torlowldus; Wear Approplate Protective Clothing; LR Response8 Torltbalde Repose <br /> Sys, Inc. ; WOO 266714 AL ' � <br /> 1 <br /> 15. GENERATOR'SIOFfEROR'9 CERT(FICATION;Ihereby dedare that ma cdnlenk of ors mnsgnmeM ere fully and acwrdey descnthe d=!, i rg name,and are classified.moraged, <br /> marked and IabekNpla2med.aM we in all respects re proper wrAition Is transport according b applicable iMemational and nal gwa Aal regi .d export snipnent and jam the Prmary <br /> Exporter 1uvtify that the contents of M asnsignroem confoml tithe terns of to deadhed EPAAamwkognimof Consent <br /> I cerl mat the waste minimization statament idenurred in 40 CPR 26212(a)(d I am a range guandly generator)c (DI(111 <br /> Ger eap�erofs Pdnted7Typed Name Signal e Mardi Day Year <br /> (� 11 0 >1 <br /> 16.International shipmena ❑anal to U5. ❑Ed can horn U.S. n <br /> = Tansio'tar signature(for expon9 any: at <br /> kaavirg U,S.: <br /> w 17.Transporter Ackraditw al N ReollH of Malwah, <br /> Traaspcde i PnMcdgypad N 5ynawre Mono Day Yaar <br /> N a� e rI o rea <br /> z TanspaMr2 Prnted/Fyped Name signatureMoam Day Year <br /> 1 19. 19(ae <br /> lea Dec epar lnda on Spay ❑ QuaMay El Type ❑Resile ❑Partial Rejects, i FWI Rejac(on <br /> Marl Reference NumCer <br /> 1W Aaamate Fachry(or Generals) U.S.EPA ID Number <br /> J <br /> U <br /> LL Fac ys Phone: i <br /> O i8a atuee of Polemate Feeairy(or GvarabriMono C Year <br /> Day <br /> Q <br /> rn 19.Hazardous Waste Repos Management Method Codes(ke.,codes for Naxadouc snare keaonenl,tlispocai,and reryc9rg systems) <br /> 1f 2. � 3. a, i <br /> L/C�• <br /> 20.Designastl ' iNyl}.rergOpeala'.CerlibraUon of rarapt of hazav'dus maredNs mvered by ore manNest axca asndad initemisa j <br /> Prime Y d Ory Year <br />