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ORDER # SJC601473 <br /> NON-HAZARDOUS 1.Generate ID Number 2.Page 1 of 3.Emergency Response Phone 0.WeNe TrecWn4 Number <br /> WASTE MANIFEST y mruosAc,< 3228 <br /> 5.Generators Name and Mailing Address Generators Site Address(g different Nan misery address) <br /> GENERAL MILLS GENERAL MILLS <br /> ATTN: WADE BROUGHTON ATTN: WADE BROUGHTON <br /> BOX 3002; LODI, CA 952411906 2000 W. TURNER ROAD <br /> Ganaamrs Phone: 209 334-7090 LODI, CA 95240 _ <br /> 6.Transporter t Company Name U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> ENGLUND EQUIPMENT CO. -]A Z D 9 8 2 4 0 3 5 8 6 <br /> 8.Designated Faccity Name and Site Address U.S.EPA ID Number <br /> VEOLIA ES TECH SOLUTIONS <br /> 5736 WEST JEFFERSON ST. <br /> PHOENIX, AZ 85043 <br /> ' Face 's Phone 800-368-9095 A Z 0 0 0 0 3 3 7 3 6 0 <br /> ga. 10.Conformist 11.TOW 12.Unk <br /> HM So'U.S.DOT Descmoncti No. Type Quantity Al 1, <br /> ¢ 1UN3090, LITHIUM BATTERY, <br /> R 9, PG II, (ERGIll D E. ss ff <br /> 2BATTERIES, DRY, SEALED, N.O.S. <br /> (ALKALINE BATTERIES - UNIVERSAL WASTE) D r n 1— <br /> 3UNIVERSAL WASTE FLUORESCENT LAMPS, ''Y,'7 <br /> USED, FOR RECYCLING - HID LAMPS / C F / <br /> 4UNIVSRSAL WASTE FLUORESCENT TUBES, USED, D F ---- <br /> FOR RECYCLING <br /> TLD <br /> 13. Spedal Handling Instructions and Additional Information <br /> 1. 271176 2. 224907 3. 224901 4. 224901 (4FT) <br /> PLACARDS PROVIDED BY CARRIER/SHIPPER YES/NO DRIVER SIGNATURE <br /> **** ER CALLER MUST IDENTIFY UNIVAR USA AS REGISTRANT **** <br /> 6 <br /> 14,GENERATOR'SrOFFERON'S CERDFICATION:I hereby declare that the contents of ms consignment em fully and acwrzlely,described above by the er skipping name,and are deserted,packaged, <br /> marked and Iabe"placamed.and are In all respects in proper condb on for transport according to applicable mat -national governmental <br /> era riroteror med'Typed Name Sig Month Day ,Year <br /> .t5.lntematianal Shpmeras ❑Import to U.S. ❑Espprt hen .S. Pon of s'. <br /> Transporter S'nature for exports only); Date le 'n US.: <br /> ¢ 16.Transporter AckruNMdDraint of Recept of Materials <br /> TT{r-a�-r�Tp`iter'rr I PdntedrTyped Name Siyayyp. Month Day Year <br /> (11 tz <br /> 12 <br /> 3 Tmnsporlef2 PrintaNyped Name �GGigmiturturra Menem Day F/Year <br /> F7 17.Discrepancy <br /> 17a.Discrepancy AWcadon Space ❑Quantity ❑Type ❑Residue ❑Pectic Rejection ❑FWI Rejection <br /> Manned Reference Number: <br /> 17b.Alternate Fadiy(or Generator) U.R.EPA tO Number <br /> J <br /> u Facility's Phone: <br /> m 17c.Signature of Aitamam Fact MY(a GaonmdoQ Month Day Year <br /> i N <br /> x WI <br /> {18.Diss9nated Faciflly OWF or Operaler.Ce ifica ion of-e Am of,,ynwals covwrd by the manlest except as noted n item 17a <br /> Pnmed/Typed Name Signature Month Day Year <br /> DESIGNATED FACILITY TO GENERATOR <br />