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Please pant or".(Form desigrred for use on elite(12-p1tch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZAR 1.Genenstor 10 Number 2 Page 1 of 3.Emergency Response Phone r,005918416 <br /> .Manifest Tracking Numbar - <br /> WASTE MANIFEST G D 9 8 2 3 5 6 9 9 1 1 800)424-9300 0 0 5 918 d 16 JJ K <br /> 5.Generator's Name and MalAddress Generator's She Address;(if d'Aferanl than mailing address) <br /> Mk)OMCRANE KRKS <br /> PO BOX 999 2373 MARIPOSA ROAD <br /> LAPORTE TX 77672 STOCKTON CA 96206 <br /> Generator's Phone: 209 464-7635 <br /> 6.Transpoma 1 Company Name U.S.EPA ID Number <br /> ASBURY RONMENTAL S RMCES C A D 0 2 8 2 7 1 0 3 6 <br /> 7.Transpolar 2 Company Nalrra U.S.EPAID Number <br /> 8.Designated I'millty Name and SNB Address U.S.EPAID Number <br /> SIEMENS WATER TECHNOLOGIES CORP. <br /> 5375 SOUTH BOYLE AVENUE <br /> _ LOS ANGELES-- OA ___90058 .......... ......... . . ... _..................................... <br /> Fadly's Phone: M31277ASM f <br /> ga, 9b.U.S.DOT Desaipbon(11dudN PrMi-Shipping Name,Harald Class,ID Number, 10.Corwinara 71.Tafel 12 UNI 13,Waste Codes c <br /> HM and Packing Group Cd my)) No. Type Quantity WUi <br /> 7. 3E2 ((s <br /> NON•RCRAHAZARDOUS WASTE,SOLID (OILY SOLIDS) �4O <br /> DM P <br /> z 2 <br /> W <br /> 3. <br /> I <br /> 4. . <br /> I <br /> 14.SpeCld HeMRng InstructionsaMAdditlonal Info bon <br /> NAERG#9B1 : 171'PROFILE#981 :AP181169OILY SOLIDS,ABSORBENT,SWEEP'POS Al1011;7 APSP JRI <br /> PERSONAL PROTECTIVE EQUIPMENT <br /> Ale <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby more that he contents of this consignment are fully and accuralety dascnbed ahove by the proper shipping name,and are dassificd,packaged, <br /> marked and labeled/placarded,and are in all respects In pmpercondition for trawpod acmrcfng to applicable international and national govenarenlal reguWgons 9 export shipment and l am the Pdmay <br /> Exporter,I certify that the contents of INs oarsignmenl notion to the lama of the attached EPAAdmowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 26227(a)of I am a large quantity generaNr)or(h)(NI am a an quantity generator)is one. <br /> Genaamr'dOSerofs Prmted?yped Nana Signature Morgh Day Year <br /> AI Me IV l /a taf <br /> 16.International Shipments <br /> ❑ImpMio U.S. El Export from U.S. Pod o/erraylexit: <br /> TranspodersignaMe(forexpmfaordy): - Date leaving U.S.: <br /> Co 17.TransporterAdaxxAedgmea of Receipt ofMatenal9 <br /> Traapaler 1 PPmt dfryped Name Si Month Day Year <br /> Z Tranepcder 2PfiMeNTyped Neme Stinson Month Day Yaw <br /> ♦ 18.Dlurepancy, <br /> 11 18a.Ncrepacy lndiration Space El Quantity ❑Typa ❑Resldue ❑Padd RsIo on ❑-ull Rejection <br /> Marifast Reference Nunben <br /> 18b.Allemals Facility(or Generator) .. U.S.EPAID Number <br /> V <br /> W Fadllys Phone: <br /> loc.Signature ofANenatt Fadlity(or Gene2Nr) Month Day Year <br /> 1212 <br /> z <br /> ti19.Hazardous Waste Report Management Method Codes(i.e.,mites to hazardous waste treahrem,disposal,and recycling systems) <br /> Q i. 2. 3. 4. <br /> 17 <br /> 1 20 Designed lisclifty Owner a Opera a fifi®tbn of rewipt of hara s M$Ls els red by the manifest except as need in Item 1 <br /> Rlnted/fyped Name SlgnaNm Moo Day Year <br /> EPA Form 8700-22(Rev.3-05) Pr us l5ditions are obsolete. DESIGNATE CITY TO D TI AT10N STATE(IF REQUI ED) <br />