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Please print " <br /> P NPs.(Form designeQfar use on elite(1$pi[ch) <br /> typewriter.) <br /> UNIFORM HAZARDOUS 1.Genendor1DNumber 2Page of 3Eme R Form Approved.OM6 No.2050-0030 <br /> WASTE MANIFEST rgenq esparse Phoria 4.ManNest TracUig Number <br /> Z 0086-951833 FLE <br /> D.Genemtofc Name aM Mailing, res ,s ile res(d diRaent n marling res) <br /> AttwJamie Haines <br /> YRC Inc. d.b.a. YRC Freight p?F Reddaaa <br /> 91-3-344-52M 100. Roe Ave <br /> ceneramr's Ptiorw 32:3 Loomis ".d <br /> . ranspalerlrry NameR&P <br /> PA 10 um r <br /> 7.TranspMer2 pang 4 •1 , <br /> AI umbe <br /> 8.Desgnand FadNy Name aM SBeAddress - <br /> Clean Harbors Sal] lode, .Lw U.S.EPA to Number <br /> 1021 Berryessa Read <br /> San J082. CA 85133 <br /> Fatly s Phone: r � _ .r) <br /> ga. 9b.U.S.DOT Demon(podding proper Shipping Name.Hamm Claes.ID Number. r U <br /> FRA and Pedit Gmup(aany)) 10.Containers 11.Total 12.Unit <br /> No. Type Quantity M..Ivo1. 13.Waste Codes <br /> o ' % 1[R11175, 14aate Wids containi.A9 flamlebla iiADid, n.o.e• N 3E2 L ;01.. LYTM+S <br /> tPoluene, Merle}, 4.1, PG 11 <br /> W 2 P nn <br /> w <br /> 3 <br /> 4. <br /> t" 14 <br /> 7 <br /> 14.Special Handling Imin,,bons ardPdtlitional Information <br /> l.^H6S4014 ?1I0#525 4455815 11x15; uRS-IV► /IqZ-Ih vlZpZb}C� <br /> H1I Job #3?„922 <br /> J eiO17445 <br /> 15.. GENERATOR'SODFFERmRS DEam inATION: lereby declare that dne contents o this consignment era Nly and accurately described above by die proper sMppirg name,aid are dass;W.ptckegod, <br /> marked and abele <br /> INplaprded,andd are n all respects in proper ccnddion for uanspoit according to applicable international and national governmental regulations.If export sHpment and I am the PrimaryExporter,I Cin y0W tha contents of this consignment conform to Cie terms of cine ataoW EPA Aduwwledgin im of Consent. <br /> I caddy that the eeste mimmuaban statement identified M 40 CFR 262.27(a)(d I am a large quantity generator)a(b)(if I am a seat quantity generator)is Nue. <br /> ref s n Neri <br /> au on ay ear <br /> 16.International Shipmentst <br /> T ❑ <br /> Lure fore on Import to U.S. LJExport ban U.S., Pad Ofauby(exit: <br /> 17.TrarepoderAWwale MnofReoeiptafMaWpis Date Wft U.S.: <br /> ransporlert rmted/T <br /> `ype <br /> _d annoy{., <br /> M Q ZZslq� ��S �. I � p^1 y ear <br /> Transpariw2 Prinledityped Name <br /> fee f �— y ear <br /> 18.Disaepa ��--II <br /> 18a.Discrepancy Indication Spam ❑ QuantityTypo Li Residue ❑Partial Re)ection ❑Ful Rejection <br /> 1— 18b-ANemate Facility(a Ganewta) Manifest Reference Number: <br /> :3 U.S.EPA IO Numbo <br /> v <br /> a <br /> �• F .. s Phare: <br /> Q18c.Signabaa o(Alternate FBty(a Gemara) Month Day Year <br /> 2 <br /> W15 fleremeu6 WaeMRepon MarmgemaidMeVnod Codes(Le,codes or hazardous"m treatment,disposal.and recycling Miami <br /> 3, <br /> 4. <br /> 1 20.DeNgnefed F Qxnernr operator cfaticaton Of recopy of ti mrdala materials covered by the man fest exaepr as noted in Item 1 B <br /> Pdn typed Name <br /> I n en Sw, mth De Year <br /> EPA 0022 1 Previous Comma are obsale e. ESIGNA D ACI L TO �R <br /> A7nr1L�4 ....i-�a.A nnxt•n.an ..,.... _.____ - - <br />