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ORDER i 452099 <br /> NON-HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST <br /> 5.Generators Nems and Mailing Address — 00000 <br /> Generator's Site Address(i different than mailing address) <br /> SILGAN CONTAINER CORP. <br /> 1615 NAVY DRIVE <br /> STOCKTON, CA 95206 <br /> Generators Plane: <br /> 66 1931 <br /> 6.Transporter 1 Com Name U.S.EPA ID Number <br /> UNIVAR USA INC. <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> MXI MAUMEE EXPRESS INC IN J D 9 8 6 6 0 7 3 8 0 <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> VEOLIA ES TECH SOLUTIONS <br /> 5736 WEST JEFFERSON ST. <br /> PHOENIX, AZ 85043 A Z 0 0 0 0 3 3 7 3 6 0 <br /> Facer s Plane: 000-368-9095 <br /> ga' 9b.U.S.DOT Description 10.Containers 11.Total 12.Unit <br /> Cc HM No. Type Quantity wt/vol.1UNIV�AT• >rL'rx_t — ELECTRONIC SCRAP <br /> DM 300 <br /> W <br /> W 2• <br /> C7 <br /> 3. <br /> 4. <br /> 13. Special Handling Instrwtions and Additional Information <br /> 1. 244612 <br /> PLACARDS PROVIDED BY CARRIER/SHIPPER YES/NO DRIVER SIGNATURE <br /> **** ER CALLER MUST IDENTIFY UNIVAR USA AS REGISTRANT **** <br /> 14.GENERATOR'SIOFFERORS CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and IebeledlplacgNed,and are in all respecls in proper condition for transport according to applicable international and national govemmemal regulations. <br /> GeneratorslOfferoes PrkttWyped Name Month Day Year <br /> '-Ca M VJ►" AAA *1 1 26 I Of <br /> 15.international Shipments <br /> Eli- import to U.S. ❑E>rport from U.S, Pat of erhtry/exit <br /> Transporter Signature for exports only): ate lea» U.S.: <br /> oc 16.Transporter Adoawledgmeni of Receipt of Materials <br /> T er 1 PrintedrTyped NameS lure Month Day Y <br /> Ca o 3 2� o <br /> N <br /> Transporter 2 Printed?yped Name S lure Month Day Year <br /> Oil <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> r 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> i; <br /> W Facility's Phone: <br /> 17c.Signature of Alternate FwAty(or Generator) <br /> Month Day Year <br /> Z< <br /> C7 <br /> W <br /> O <br /> 18.Designated Facility Owner or Operator:Certification of receipt of materials covered by the manifest except as rated in nem 17a <br /> PdntedrTyped Name Signature Month Day Year <br /> DESIGNATED FACILITYTO GENERATOR <br />