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- 'Please oriaf B[.Nna fFnw HAalnnad fnr usA m alit I19 <br />', lR, l h—.' nn.:r <br />Ifl(Ihlllll�lIIIIIIIIiNil11111111111Ifll�fflulllllllll!!I(II!!!i; <br />_pHAton11dtuu-a(rc@¢'sub)-PreviousemticTsart obsolete, all A. DESIGNATED FACILITYTOGENERATOR. <br />nppmvVU, vmD.No. z4oI uwW <br />UNIFORM HAZARDOUS -.1. Generator ID Number ' - : - 2 Page9 M 3. E enc�yIRe ones PMna 4. Manifest Tackinng Nju�mnbar 'fA <br />CA00009006 4 <br />WsLSTE MANIFEST ... 1: ( 1)(.1)i0•r8j, i7 �a1,),q, <br />t7 <br />4%0111f Nee vi%N11W117RC FREIeHT`/-JAMIE HAINES' 1E'Plii as <br />10990 ROE AVE, MAIL STOP A 605 3233 LOOMIS RD <br />OVERLAND PARK KS 66211 STOCKTON CA 95205-=8010; <br />(2W 466-2901 GEN. 313§0+ <br />Genaratora Phone:.- - - - <br />6: cans""��rteri pony Name - U.S. FPAJD Number-- <br />HE)tI7ASE TRANSPORI, LLC- TS HAYWARD IND0Number 14 <br />7. Transporter 2 Company Name U.S: FPA ID Number - <br />B r(C9'il l sillyN r�6�'4 MWgTAL SERVICES U.S, EPAID Number <br />Pttl <br />2284 E STOREY RD AZD081705402 <br />COOLIDGE, AZ 851iN-9205 <br />(520)723-4167 <br />Facility's Phone. " .:. ... . ... -.. - :. <br />ga . <br />9b. U.S DOT Descripiton (Including Proper Shipping Name, Hazard Class, ID Number <br />10. Coniainam <br />-14. Total <br />12 Unit <br />HM <br />sand Packing Gidup (If any)) <br />OuanOry - <br />WtNol.' <br />13. Waster Cod <br />No. - <br />Type <br />o <br />NON.RCP.A HA7-.APDOUS WASTE SOLID (ADHESIVE' <br />241 <br />4a <br />iF DEBRIS) <br />2' P1o+.i Q.CQp N A2A¢:g?wS �.1:wg1g`e Sot.2q <br />.. <br />A 14'1 <br />3 , .. <br />Ave li i�s% ns and Additional lnfonnatim <br />1.° ,- '�t <br />PRO# 39i—=53545BA-C; JOB # 33822 <br />ERI -,EMI 148914893 GT. <br />15. GENERATOR' FFERO S CERTIFICATION: hereby declare Nat the conlents of Nis consignmeni are lully and acaretely described above bythe proper shipping name, aro are classified, packaged, <br />marked and labeled/placarded, and are In all respects in proper condition for transport according to applicable intemadonal and nalional governmental regdations.0 export sN.pment and l am the Primary . <br />Ezpormr*, I cm* Nat the contents of this consignment.cenform to the terms of the attached EPA Acknowledgment of Consent. - - - - - ' <br />I'carby t at thewasteminimizationmaieineritidentifiedin40CFR 62.27(a)'(81ama large quantirygenerator r fl am a small,quan0ty generator) is boa.enema <br />es rite, y ams -^ igna ur ,.Monin Day Year <br />U're CQ v <br />I_ <br />16. Int all nal Shipments _ _ <br />I ❑ Impoato U.S. ❑ Export from U.S, Port of entryl t, <br />Trans orter si naWre for exports only): Date leaven U.S.:' <br />W <br />17. TansporterAcknowiedgmegt of Receipt ofMatmils , <br />framporter'I Finmnyi)60 Name ... - ra - .. -Month Day yew <br />o <br />II-- <br />U-thI v `ear <br />GTansportar2PdntedfTyped.Name <br />: - ria e - <br />111 <br />18 Discrepancy <br />{ <br />189. Dtscmpamcy Indication Space ❑ Ouanety ❑ Type y � ❑ PeNal ReJechon ❑Full Reject an <br />18b. Aliemate Facility(or Generator) - _ .. US..EPA,.IDNumber <br />_ <br />MAR 17 2015: <br />FaDli ePhpne: -' - <br />Fka <br />a <br />tam <br />10c.Slgnatureot ate Facility Generator) - - - Month Day Year <br />ENVIRONMENTAL '. <br />Z <br />h19. <br />Hazardous Waste Report Management Method Codes lie, codas for hazardous waste treatment, disposal, and recycling systems- - - - <br />9.I <br />Hi4i <br />2 3. <br />4: . <br />26, Designated FacilitypwrienorOperator. Cedificadon of receipt of hazardous materials Covered by the manifest except as need In Sem iOa , -. <br />Pdntedgyped Name 519nature Month 'Day ear <br />_pHAton11dtuu-a(rc@¢'sub)-PreviousemticTsart obsolete, all A. DESIGNATED FACILITYTOGENERATOR. <br />