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Please print or type. (Form desioned for use on elite (1241tch) tvoewriter.) <br />Form ADoroved. OMB No. 2050-0039 <br />UNIFORM HAZARDOUS <br />1 • Generator ID Number <br />(_: J398 25{ 8251 <br />2'Page 1 of <br />3. Emergency Response one <br />i 264-521,,,nnl <br />4. Manifest Tracking Number <br />6 F <br />WASTE MANIFEST <br />023) <br />386606G <br />5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) <br />L-nfficd (Tro :ers, Inc, Unified &oL,en, Ins.. <br />Aztentum: Envir umntal H:ail;'t & Safety 1900 Picuiti Road <br />5200 g Leila Street Commerce Ca. 90040 Stock -ton. Ca. 95215 <br />Generator's Phone: <br />6. Transporter 1 Comp p me .- - L' ` ` U.S EPA ID Number <br />Sim JpagWn F Iter Recycling C AL00010275I <br />7. Transporter 2 Company Name U.S. EPA IO Number <br />8. Designated Facility Name and Site <br />IMP? .l,.,T {, aCfr�1- U.S. EPA ID Number <br />14-187 L. NlaiiY'iae F'#irfi%; , i2A. j36'8 <br />i 559A -#p8-0240 CA L000102751 <br />Facility's Phone: <br />9a <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt.Nol. <br />i <br />1.�. 3,"\-. i1: `:.:i t iy.. ✓.+�}.if `t7�:, �:'1' tis3�t:.. - <br />r..w. <br />o <br />Ligui d- (LFsed X P"wfixed Oil)...... <br />t.. <br />_.=. - <br />%1ZZYR1 <br />z <br />W <br />2. <br />C <br />FL�11 <br />V 16 Lmf <br />3. <br />J U <br />4. <br />ENVI <br />ON <br />EN�IAL H ALT <br />DE <br />- <br />t7 <br />14. Special Handling Iristru nrd Add(Go� l lnfortnatlgn,k Yr�ti i rS� ; ;�� � (`}il ' <3PPropriate Personal Protective <br />3 1 ! 1 <br />Equipment <br />15. GENERATOR'SIOFFEROR'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, <br />marked and libeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. <br />Generatoes/Offeroes PrintedlTyp d Name ' . Signature Month Day Year <br />Oy o� <br />1Q2 <br />-J1 <br />. n ema onal Shipments <br />Import to U.S. ❑ Exporl`from U.S. Port of entry/exit: `. <br />LJL <br />z <br />Transporter signature (for exports only): Date leaving U.S.: <br />UJ <br />17. Transporter Acknowledgment of Receipt of Materials <br />E <br />Tran orter 1 PrintedlTyped Name , Sign Month Day, Year <br />QTransporter <br />ZPrintedrryped Name Signature Month Day Year <br />t-- <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ Quantity ❑ Type Jr ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />J <br />v <br />Facility's Phone: <br />W <br />18c. Signature of Altemate Facility (or Generator) <br />Month Day Year <br />z <br />� <br />N19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />G <br />1 <br />2. 3. <br />4. <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as nItem 18a <br />Printed/Typed Name Signature Month Day Year <br />