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Plte . or W&(Fafrn ed for use on elite(12 Itch ., Twran ►ro:2460 0039 , <br /> 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.M&n iniad rarrlxer <br /> lllilFOf�llfl irTAttDOU$ CAT()k) 11949 I83�i 3c" lac 1 n <br /> WqS I�FW <br /> Y) f DAN AE€�EZ 4a � nt bf�I� PE�tEZ <br /> 4404ST�VALPICO ROAD-SITE 400 WEST VAt..RICID ROAD--SITE <br /> TRACY, CA 9S376 TRACY CA 95376 <br /> (209)836-1971 GEN: L44`9 <br /> Ptlwie:. <br /> U.S.[EPA ID Number <br /> TRIAD TRANSPORT, INCORPORATED OKD981588791 <br /> 2 Y tam U.S.EPA ID Number <br /> T.Tw"oft U.S.PAID Number <br /> WN1'AL SERVICES LLC,. <br /> tSWTOREY RDAZf3fi 81 >�ftU <br /> , AZ 85228 <br /> FadM Raw . (521))723-4167 <br /> ge 8b.U.S..DOT Dew*don(Induding Proper Shlpping Name,Hazard Class.ID Number, 10.Containers 11.Total 12.Untt 13.ftste Codes <br /> HM andPaddn®Grorrp.(N01)) No. Type Quantify tfVtlVd. <br /> X. . -NA. NON RCRA HAZARDOUS WASTE SOLID, <br /> I, (CIIL FILTERS),661"A" <br /> >€ 2 #'iQN #tCR�i HAZARD" WASTE Lltliill}, ( � 1 <br /> (USED ©It_),E-R6#t" <br /> ' NON RCRA HAZARDOUS i TE S�ILID ( Y <br /> BENTS f� . a: <br /> r <br /> 4. <br /> MET <br /> NONDRCRA HAZARDOUS WASTE 60f.I1} (EMPTY 7U0 <br /> IV 17 �. 2.W 1 Q5'3e 237 3.WE0532a99 4,W i O 0532523 <br /> x; <br /> L135199 ]S <br /> 15. ATOR'SNOFFEROR'S CERi1F"ICATIDN: I hereby declare that the contents of this consignment are fully and accurately described above by the proper slnipping nerve,and aro desWed,packaged. <br /> merited and InbeWplararded,and are In d respects in proper condition for transport according to applica6lg_'. and ne8onal goverrimental regulations.If export shipment and I am the Prbnery <br /> F�orler i.aer*Met the contents of this auasignmant conform to the farms of the aeached EPAAcIw*adg <br /> I c9*0W the waste dninuaw statement idw#W in 40 CFR 262.27(x)(If I am a huge quantity gwwatM of(6)(N].a9te A quantity whue. <br /> Signature F e mom Day year <br /> 18.wd@weUonal Sf mwft ❑Import to U.S. + *❑Fop from U.S. Port of entrylexH: <br /> Thinagorter na n for Data leaft U.S.:. <br /> 1I.TterteporlerJidtirorrled8rfrent Of Reoelpt Of Alsterixls <br /> Name sqinature Month. Day Year <br /> h��z 111 /0 <br /> OF 2 <br /> ear <br /> !&Discrepancy <br /> 18s.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Refection ❑Full Rejection <br /> Manifest Referenoe Nurrd : <br /> 18b.Ntxnate FW4(or Generator) U.S.EPA ID Number <br /> loc. Pture o Alternate Fadllfy(or Generator) Moxth Day Year <br /> 19.Haxardoua VY�te Report Management Method Codes{I.e.,codes for hazardous waste heahnant,disposal,and recycling systema) <br /> 1. 141 2 1 1413 H141 4 H141 <br /> 2D.Designated Facility Owner or Operator:Cartificalim of receipt of hazardous materials covered by the martfeet except as noted in Item 18a <br /> ntedllyped <br /> New ftnature Month Day Year <br /> EPA Form 8 5) PrOlods-ediffnis-affobiblete. J DESIGNAT AGILITY TQ GENERATOR <br />