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Please print or type.(Form designed for use on elite(12-pAc 'ter.) _ Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number (.;4� 1F:Ir.1 Q`cai�li% r. %" U d'4'[n...i F:=J.7 WASTE MANIFEST - 0037.L04991 F L E 5.Geneator's Name and Mailing Address Generator's Site Address(if different than mailing address) h^rel k+ti'r PESCADER[I 7F TRACY CA T204 Genemimes Phone: 2k'tJ c.' :1'-71` 1^`•! - - 6.Tronsporw 1 Company Name - U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 0.Designated Facility Name and Site Address S r., 1 NIC., U.S.EE,I'ID Number F'u�rEl"t i{i_Li�l� SYSTEMS,, 1 1722 COOPER !,REEK ROAD, Dl-.N ,, TX 76208 .1rfh-�;i;_•4_.si.111-tr,, _ 7k %�+7'T5�3371 Faglitys Phone: -.5 - _ 9a 9b:U.S.DDT Description(Induding Proper Shipping Name,Hazard Class,l0 Number, 10.Containers 11.Total 12.Unit 13.Waste Codes XM and Packing Group(rfany)) No. Type Quantity WRNd. }11e1 WA`>TIS t::Ta r T '40.-r'' .az^{'j-r a 9 -TIT" rt .m Y 1. o I:14�1.-6 f hit- - i.1 CDO01; DO 4A 3.s? DILITS LIDUID, N. O.S. -D Fsa. FUEL) .%T-12 Al Pro I I t � �, -2 � 3 4 rJiJ C ;'t- 3. NON RCRA H#`Z;ARPt7Liv WASTE LIQUIDS � D14 37 E'i_' rus�8�- ;USED OIL) I , 4 wwa;Rp.. t4units1t3 s wtwi_ i_ioula:7i4 F 2s 1 ^U rWISED OTLA5 14.Special Handling Instructions and Additional information t }Z r n r. le, .^'•`r'll��s":4�f%,_-1Fi2663 `:2422.507 Si 2 7 4117 24 Hk "IEPt ENCY EIAt af.8 11611 1 SPF .}. t(LcE^ +13 ? ;id EN)1171'.' Zr1 !$h-.. .^-•l.U�irrr lEhf! •M1i(t17ci ). s F! . 2 �{a.1 -1�'!'±Y.F`'✓•t1 15. GERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified packaged marked and Labeled/placarded,and are In all respects In proper condition for transport according to applicable international and national govemmental regulations.t export shipment and I Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAclmowledgmgnt of Consent J I '- I certify that the waste minimization statement identified in 40 CFR 26227(a)(t I am a large quantity generator?Sf(b)(t I a it quanti enerator)Is bus. Genep} s/011emes Pd dlF ped Name Igna re i- .wher eat u�iJ IS o cv+-1� -t✓ 16.International Shipments - -- F ❑Import to U.S. ❑Expert from U.S. Pont ofentry/exit -Z - Transporter si nature for exports only): Data leaving U.S.: ' V.Tmnsporter Acknowledgment of Receipt of Materials Trensporter4 PnnteNTyped Name IgnaWreMonth Day Year C0 y } ,✓,x .i�. �..,i.�� -7.yz�f/.�/' I .1^' ..r�y""r' ,�� J 'r;I 1 sj Z Transporter Pnnted/iyped Name `4 ignaWhe... ear tu 18.Discrepancy . 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑FUR R' on Manifest Reference Number. 186.AItemate,Facility for Generator) -' U.S.EPA ID Number J G3 LL Facillys Phone: w 18c.Signature ofAltemate Facility(or Generator) - _ Montt Day Year tr Q Z 19.Hazardous Waste Report Management Method Codes i.e.,codes for hazardous waste treatment,d' ) U.y po 9e ( disposal,and recycling systems 4. 1 20.Designated Facility Owner .or 0peator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pnnted/Typed Name Signature Month Day Year EPA ForTn 870¢ (Rev.3-05) Previous editions are oboq!e izhvu�*n. -n ? / GENERATOR'S INITIAL COPY .:t t4,�:�.! �.;';_IiI ;.?->2l:�tl'14i t :i:.'_l�