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Please print or type.(Fen designed for use on elite(12-pitch)lypewiten) ORDER 11 <br /> Formap60yea40Me <br /> pro No.2050-0039 <br /> UNIFORM HAZARDOUS 1' "eraWr 10 Number 2.Page 1 of 3,Emergency Raspanse Plmnn 1.Manifest Tracking Number <br /> WASTE MANIFEST Lm <br /> C A D 9 8 1 3 9 6 0 2 1 2 900-53 5053 0 0 7 5 2 3 7 3 6 JJK <br /> 5.Genemers Name arM Mailing Address Generators Site Address(if different Nen mailing address{ <br /> GENERAL MILLS GENERAL MILLS <br /> ATTN: WADS BROUGHTON ATTN: WADS BROUGHTON <br /> BOR 3002; LODI, CA 952411906 2000 W. TURNER ROAD <br /> Genemta's Pham: 209 334-7090 LODI, CA 95240 <br /> 8.Transporter 1 Company Name U.S.EPA ID Number <br /> UNIVAR USA INC. IC A D 0 1 0 9 2 5 7 6 <br /> 7.Transporter 2 Company Nems U.S.EPA ID Number <br /> ENGLUND EQUIPMENT CO. JA Z D 9 8 2 4 0 3 5 8 6 <br /> 8,Designated F6ciRty Nsma and Ste Address U.S.EPAID Number <br /> TRADEBE TREATMENT AND <br /> RECYCLING LLC <br /> 4343 KBHNSDY AVENUE; EAST CHICAGO, IN 46312 <br /> FaahiNPhone: 219-397-3951 11 N D 0 0 0 6 4 6 9 4 3 <br /> Sal. 9b.US.DOT Dariod n Reducing proper Shipping Name,Hanoi Class,10 Number, I0.Cala tiers 11.Total 42,Unit <br /> HM arm Prang Greup(ilanyl) No. Type Quanety WtNul, 13.0hastecoms <br /> 1NON-RCRA HAZARDOUS WASTE, LIQUID <br /> p (WATER BASED VIDEO JET INK) D F. L.,__....._. <br /> � <br /> 2 CRAZY <br /> 2NON-RCRA HAZARDOUS WASTE, LIQUID j <br /> (WASTE OILS) D M <br /> C I <br /> 221 <br /> 3NON-RCRA HAZARDOUS WASTE, SOLID <br /> (DEBRIS WITH OIL) A D M <br /> 352 i <br /> 4NON-RF'RA HAZARDOUS WASTE, SOLID 1 <br /> (EMPTY METAL DRUMS) FM <br /> (y(/ j512 <br /> 14.Spatial Handling ImWctions antlpddNoml Information <br /> 1. 03090174LE 2. 01020698LF 3. 01020591NE 4. 01020592NS <br /> PLACARDS PROVIDED BY CARRIER/SHIPPER YES/NO DRIVER SIGNATURE <br /> **** ER CALLER MUST IDENTIFY UNIVAR USA AS REGISTRANT **** <br /> 15. GENERATOR'S/OFFEROR'SCERTIFICATION:Iherebydedare that Necmtenls of mis consigmnenl are full acarztetytlescrised above by the pmpershippiogname,and areGassifed.packaged, <br /> marked and Abated/placarded,andaremaltrespectsm propararudrtion fertansportaccordingroapplicable intemationelard notionalgovemmemai regulations.haaporishipmax end I am the Primary <br /> Expaltar,I cedHy that Na contents of his camsounenl conform to the lams of the attached EPAAcknewledgmenl of Consent. <br /> I unify Natthe waste minlmvatton statement identified In 40 CFR 26227(a)(8I am a large quantity generator)or(b)(I am a 1 quanNy,generator)Is It <br /> tors PriffTyped Nam I Signal Mon Day Vey <br /> E Z !// <br /> J <br /> 1b.memadenal 5nipari, <br /> i- <br /> 1-11mrs oU.S. ❑Export from U.S. Portofeatryl <br /> Transporter signature(for exports"�IY): Data leaving .S' <br /> w 17.TrenspaterAdmvgedgmentofReuiptofMatedals <br /> OTranr 1 P'nledRyped Name F S19na Month Day Year r <br /> H <br /> 2 Transporter 2 Pdntedllyped Name lisgroature U, Day Year <br /> } 18.Discrepancy <br /> 18a.Discrepancy Im&atian Space ❑ Quantity ❑Type ❑Residue ❑Parrat Rescue, ❑FUR Rejedbn <br /> Manliest Reference Number. <br /> 181s.A8amme Faaiiq(or Generator) U.S.EPA ID Numper <br /> J <br /> V <br /> fora. Fadlltys Pham: <br /> 076 <br /> .Signi of Aftemate,Facility(or Generator) Monty Day Year <br /> N19,Hazardous'Waste Report Management Method Codes(i.e.,atlas for hazardous waste Headmen,disposal,and recycil systems) <br /> 1. 2, 3. 4. <br /> 20.Designated FaMity Owner or Operetor Cerfifiuten of receipt of hvzntous mmenals uvared by tha manEet except as noted in/tom IBe <br /> PnntetlrTyped Name Signature MOMh Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous edthi are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />