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Apr 29 16 1 0:61a King Isand Enterprises 209-477-4364 p.2 <br /> Please print or lyse.(Poon derall;nec for use ! <br /> 22 elite Eh( p <br /> '12-pltch)tyerwir[her.) Form Approved.OMB No.205MO39 <br /> UNIFORM HAZARDOUS 1.Gea�ator <br /> WASTE MANIFEST :7 .7; <br /> S Gereract's Name and MallingAddreses SKS <br /> Gaireprws3ta*0hvi Ife adifteres <br /> ease, 1-. i <br /> L <br /> Generalon Pharvic <br /> 0.Traspmerj COMP".1111-me L U.B.EPA ID Nunber <br /> 7.Ininspader 2 Corighliny Nam <br /> a D099VIDd Facl ty Nam and Sftamraea <br /> US.EPAILNumbs <br /> Facll?a-hew <br /> 9a, St.US-DOT01hiscriphort lincliting Proper Shipping Name,Hazard Class,ID Numlbel <br /> HIM and Park ng Gri(I any),, C-bc— 11,Taw 12.Un t <br /> No. Type Quarrilly wlivo, 13.7haft Codes <br /> me 7 <br /> Z 2. <br /> 3. <br /> 4. <br /> 14,Special Handing kistrincolons andAddtonal Irdomation <br /> q <br /> 15 GENERATOR'SKIFFIRMSCERTIFICATIDIN:I herebydadamlhat:hewntsntsoftrsmn§gimmtarefilryard ac tEIydeswbedabXe thytheitimwshippirg maw,and anaclassilied packaged, <br /> marked and:sbeleclifelawnded,and main all resperls,in p,upercerchim for transport according b appkable labefrialbraland national gim"inneralial Mgu agans foxxil shipment and In ft Primary <br /> EXPc1hXI00r1fl9 1ha:h0 001theirts 01 this cnnsgnwent mintrin to Ihekms of this awed EPAACknowedgment of Consent. <br /> for eiprerrr(sPPinledJTyped Nam me <br /> 14.1h Day' Year <br /> -j l"Mational birprients <br /> El 'wo 1,U1. El E,pw ft,.U.S. Ptratoferiverith. <br /> Oferexparsono: Date haviv U.S.: <br /> olMalwids <br /> C Transporter 1 PrinledfTyped Name;', Signature Mont Day Year <br /> Signearan, lAwth Day Year <br /> 1B.Discrepancy I <br /> 18e.01screparcyVicallism Spam ❑o..dtY LJ 7yp, ❑Residue ❑ ❑F.1 Rq.,t,, <br /> Manifest Refransehe Number. <br /> 18h.Alternate Pettily(or Cieneraherl U.S.EPA ID Nuri <br /> Fs*�,s Phone: <br /> dw18l Signatkire OfANAmele Facility(w Genems") k1cmin, Day Year <br /> where%pzft Marmagenritill Melhod Codes ll.a.,modes W hicrardOLISMSM,assartaAL disposal,and recyclaq systems) <br /> i 2. 3. 1. <br /> 2D.Dassgrjated FacIlly Owner or Operrabor.Cerlircalion 0fraDept al hazardous mlerals;coneredby tv manhiest excepi hided h ren 18a <br /> Sign <br /> seem war <br /> r <br /> ICE <br /> EPAFonm 37013-22(Rev.3-05)_F4SViDLlS adiitlons are obsolete. <br /> DESIGNATIETFAICILrYTO GENERATOR <br />