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'% . <br /> ORDER # 454694 <br /> Please punt or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C A D 9 8 0 8 8 4 8 1 1 2 800-535-5053 003512478 JJ K <br /> 5.Generator's Name and Malting Address Generators Site Address(if different than mailing address) <br /> SILGAN CONTAINER CORP. <br /> 1815 NAVY DRIVE <br /> STOCKTON, CA 95206 <br /> Generator's Phone: _1 11111 <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 2 Company Name U.S.EPA ID Number <br /> MXI MA UMEE EXPRESS INC TJ J D 9 8 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 90OS8 <br /> Facliys Phim: 323-277-1500 C A D 0 9 7 0 3 0 9 3 3 <br /> ga_ 9b.U.S.DOT Description(including Proper Shipping Name,Hazaro Claes,ID Number, 10 Corrainer, 11 Total 12.Unit <br /> HM and Packing Group(rf any)) 13.Waste Cods <br /> No. Type Quantity WtNol. <br /> 1.RQ, WASTECORROSIVE LIQUID, ACIDIC, INORGANIC, DO02 <br /> O.S., (COPPED SULFATE, HYDROCHLORIC ACID) t D <br /> X 9, VN3264, Pa II, {R(2=100}, (ERG#154) <br /> w <br /> 792 <br /> z 2. <br /> W <br /> t:7 <br /> 3. <br /> 4. <br /> 14.Special Handing 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 REGISTF.ANT **** <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately descnbed above ty the proper shipping name,and are classed,packaged, <br /> marked and labeledlplacarded,and are in an respects in proper condition for transport according to applicable international and national governmental regulations If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the t[rms of the attached EPAAdmowledgment of Consent <br /> I certily that the waste minimization statement identified in 40 CFR 262.27(x)Of 1 am a large quantity generator)or m a small quantity generator)is true. <br /> Generalor'sl0(f nled/T ed amo Signet Month Day Year <br /> f Cc PM, <br /> 16.Ina tonal Shipments <br /> Z ❑Import to U.S. ❑Export from U.S. Port of entry/exit <br /> Transporter signature(for exports only): Date leaving U S.: <br /> Liu 17,TransporlerAdmowledgnent of Receipt of Materials <br /> OT 1 Printed/Typed Name Sig Month Da Year <br /> 7.0 �m t� S a� I <br /> z¢ Transporter2 Printed/Typed Name Si aWre Month Day Year <br /> f-- <br /> 18.Discrepancy <br /> Ise.Discrepancy Indication Space <br /> Ouerbty El Typo ❑Residue ❑Partial Reledicn ❑Full Rejretion <br /> u Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA 10 Number <br /> U <br /> r¢+ Facility's Phone: <br /> C3 !Be.Signature otAllemale Fadlity,(or Generator) 6hn;n Cay Ycar <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> w 1 2. 3. 4. <br /> C3 <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manffest except as rated In item Ise <br /> ilonted/Typed Name Signature „1crtn Day Year <br /> EPA Form 8700.22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITYTO DESTINATION STATE(IF REQUIRED) <br /> VOO[j SaIVS XXV9HaAI8 F N0131301S NVDIIS I�'S6 996 60Z XVI 6Z:ST 8006"/TT/60 <br />