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Iq <br /> Please print or type.(Form designed for use on elite J12-pitch)typewriter.) ORDER ;f 4.55469 qq <br /> P ) ) Form llpproved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.ManifeW Tracking Number <br /> WASTE MANIFEST C A D 9 8 0 8 8 4 s 1 1 2 $00-535-5053 003512478 JJ K <br /> 5.Generator's Name and Marling Addross Generators Sita Address(if different than makhg address) <br /> SILGAN CONTAINER CORP. <br /> 1.61.5 NAVY DRIVE <br /> STOCKTON, CA 95206 <br /> Generator's Phone: _ <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> UNIVAR USA INC. C A D 0 1 0 9 2 5 5 7 6 <br /> 7.Transporter Company Name U.S.EPA ID Number <br /> MY.I MA t1MEE EXPRESS INC N 3' D 9 6 6 6 0 7 3 3 0 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> SIEMENS WATER TECHNOLOGIES CORP. <br /> 5375 SOUTH BOYLE AVE <br /> VERNON, CA 90059 C A D 0 9 7 0 3 0 9 .) 3 <br /> Facility's Phone: 323-277-150 <br /> 9a 9b.U.S.OGT Description(including Roper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group V any)) No. Type Quanfity WINol' 13.Waste Codes <br /> Elf 1. ,---WASTECORROSIVE LIQUID, ACIDIC, RGANIC, <br /> .O.S., (COPPER SULFATE, HYDROCHLORIC ACID) /r D002 <br /> O X 8 UN3264, PG II, (R(- D I 100}, (ERG#154} (� <br /> 792 <br /> LU <br /> z 2. <br /> LU <br /> C9 <br /> 3. <br /> 4. <br /> 14.Special Handling instructions and Additional Information <br /> 1. 3592162 <br /> PLACARDS PROVIDED BY CARRIER/SHIPPER YES/NO DRIVER SIGNATURE <br /> **** ER CALLER MUST IDENTIFY UNIVAR USA AS REGISTRANT **** ---- <br /> 15. GEN ERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that the contents 0 this consignment are fully and accurately described above by the.proper shipping name,and aro classified,packaged, <br /> marked and labelediplacarded,and aro in all respects in proper condition for transport according to applicable Intemallonal and national governmental regulations.if export shipment and I am the Pr9rary <br /> Exporter,I certify that the contents of this consignment conform to the forms of the attached EPAAclmwiedgment of Consent <br /> I cenily,that the waste minimization satement identffied in 40 CFR 26227(x)(f I am a large quantity generator)or m a small quantitygenorator)is We. <br /> Generatorse tedfi ed erne Signa Month Day Year <br /> 16.Wernfiilotiul Shipments <br /> F- ❑Import to U.S. ❑Expert from U.S. Port of enirylexiC <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> Lw 17.Transporter Acknoriedgjnent of Receipt of Materials <br /> oTran error 1 Prhtedffyped Name Slg Month D Year <br /> Q Transporter 2 Printed/Typed Name S' ature Month Day Year <br /> 18.Discrepancy (—1 ll�� <br /> 18a.Discrepancy Indication Space Quantity L.i Type ElResidue ❑Partial Refection L1 Full Refection <br /> Manifest Refemnee Number, <br /> :318h.Alternate Facility(or Generator) U.S:EPA ID Number <br /> U ' <br /> .. Facility's Phone: <br /> LU 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> a <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes far hazardous waste treatment,disposal,and recycling systems) <br /> LU i. 2. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted In Item 1 Ba <br /> Renta yped NamoSgnature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> b00In SHIVS XNVg9HAIH f- NOJINDOIS ISIV9'11S 1996 996 609 YVA 67. :91 8009/TT/b0 <br />