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h <br /> Please print or We.(Farm designed for use on elite(12-pitch)typewntet) FonApproved.OMB No.2050-0039 <br /> UNIFORM I'ti�Yma^r�US 1.Generator 10 Number 2.Pege 1 of J.Emergency Response Phone g.Manliest Tracking Nmnber <br /> WASTE MANIFEST c A D 9 'B 2 3 S 6 9 d 1 11 1*8001 424-93on 005921229 JJ K <br /> 5.Genambok's Name and Melling Address nemlors Site Address to different than MAng address) <br /> WXMCRANE WORKS <br /> PO BOX 938 2373 WIPOSA ROAD <br /> LA PORTE TA'. 77572 STOCKTON CA %206 <br /> Genaamrs Pirrone: - > <br /> B. <br /> Transport, <br /> Company Name U.S.EPA ID Number <br /> C <br /> 7.Traspoda 2 Compery Name , . - U.S.010 NUMer r' <br /> is <br /> A.Designated FadMy Nemo and Site Address, U.S.EPA ID Number <br /> SiENENS WATER TECHNOLOGIES CORP. <br /> 5375 SOUTH'BOYLE AVENUE <br /> _.... .- . ... COS ANGELES..... _ CA: ..�M _ _ _ C -A-..p....6...9._7-..A-3 0 9 9 3 g <br /> Fad sPhone: .- kb <br /> ga. go.U.S.DOT Descriptian(Inducting Proper ShWing Name,Hazard Class,ID Number, 10.Comalnem 11.To191 12.Unit 13,Waste Codes 1' <br /> HM and Padi g Grow(If aRY)l No. Type Dual WtNd. f <br /> 1. <br /> K <br /> NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLIDS) oZOGj <br /> z 2. <br /> w <br /> c7 I <br /> 3. <br /> i <br /> 4. <br /> 14.Special Handling instructions and Additional Inlcrmation <br /> NAERO#991 : 171'PROFILE#981 AP1810 OILY SOLIDS,ABSORBENT, SWEEPPOO Al 10111791 •APPROPRIATE <br /> PERSONAL PROTECTIVE EOUIPNENT <br /> 15. GENERATORS/OFFEROR'S CERMCATION:I hereby dedare thetthe contents of this consignment are fully and accurately delscribed above by the proper shipping pro,and are Classified,packaged, <br /> marked and ladelecitplacaded,and are N all respects In proper condition for uensport acmMng to appNrable lntematbnaland national governmental regulations.if enod siipmem and l am the Pdmary <br /> Exporter,I cooly that the contents of this condgnmera=too to ata terms of the attached EPAAcknowiedgmanl of Consent <br /> I certify that the waste minimtrzrion statement Identified M 40 CFR 2e227(a)(if I am a large quantity generator)or a small an5ly generale)Is true. <br /> Generetofs/Olferofs PdnledlFyped Na1 Signatu Month Day Year <br /> me <br /> qn <br /> L _'w1 L <br /> 16.international SNpmenis ❑Import t U.S. ❑Fxport mom U.S. Port entrykdt: <br /> ? Transporter signature(lie expand;opy): Date leaving U.S.- <br /> 17. <br /> .S:17.TransporterAGknomedgrrent of Receipt of Mdeids <br /> Transporter 1 PrinteduT me ® / Signature Month Day Year <br /> a lC W <br /> QTmnspcder 2 PdntedRyped Nome Sig Month Day Year <br /> } 18.Discnepacy <br /> 18a.Ducrepancy Indication Space ❑ OuenGly ❑Type ❑Residue ❑PNBd Rejecaort ❑Fug ReJacUon <br /> Mansest Reference Number. <br /> 18b.Alternate Fa ility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL FacdTJs Phone: <br /> aW 18c.Signature f AltemNte Focally(at Geneator) Month Day Year <br /> Y <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,cedes for hazamaus waste treatment,dis)asa,aM regdmA systems) <br /> W 1 2. 3, 4. <br /> 0 <br /> 20.ossigrmled Fedlty Ow ar Operamr.0 c wOtmreceiptofhazamous teials ve the manifest except as nded In Item lea <br /> Name Signature Month Year <br /> EPA Form 97W22(Rev.3-05) Previ a ns are obsdete. DESIGNATED FACILITY TO ESTINATION STATE(IF REQUI ED) <br />