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/75 <br /> CFTIER # 4`.469! <br /> NON-HAZARDOUS 1.Generator ID Number2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number <br /> WASTE MANIFEST C A D 9 8 0 a S 4 8 1 1 3 800—5.35—5053 <br /> 5.Generator's Name and Mailing Address Generator's Site Address(If different than mailing address) <br /> SI LGAN G'ONTAT NEP. CARP . <br /> 19_5 NAVY D'RIVz: <br /> STOCKTVN, CA 95206 <br /> Generator's Phone: 209 466-1031 <br /> 6.Transporter I Company Name <br /> U.S.EPA ID Number <br /> UNItiA.R USA INC. <br /> C A. D U 1 li `3 ? 5 5 ir.; <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> t�tI D9T-.UNIEE EXPRESS INC N J D 9 $ ; h 0 7 3 c' <br /> 9.Designated Facility Name and Sde Address U.S.EPA ID Number <br /> VEGLIA ES TECH SOLUTIONS <br /> 5736 WEST JEFFERSON ST. <br /> PHOENIX, AZ 95043 <br /> FaciA 's Phone: R00-368-9095 - <br /> 9a. 9b.U.S.DOT Description' 10.Containers 11.Total 12.Unit <br /> HM <br /> No. Type Quantity Wt.Nol. <br /> 1 UIJIVERSAL WASTE — LAMP'S , _ -- <br /> ¢p !SPENT FLUORESCENT LIGHT TUBES) <br /> w <br /> zuj <br /> 2. - <br /> cj 1 <br /> 3. <br /> _FF4 .I•.YR:•r <br /> 13. Spacial Hip Instruclions and Additional Information <br /> 1. 522724 <br /> PLACARDS PROVIDED BY CARRIER/SHIPPER YES/NO DRIVER SIG3NA I.T-T <br /> **** ER CALLER. MUST IDENTIFY UNIVAR USA AS REGI'TI:APtT *—A- - - ---- <br /> ' 14.GENERATOR'S/OFFEROR'S CERTIFICATION:I herebydeclare that the contents of this consignment are full and axuralel described above b the mer shipping 9 Y Y Y P p Aping name,and are classified,Packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international e d national governmental regulations. <br /> Generator' bes PdntedrT ed ame Signet Month Day Year <br /> If o I. s i . log <br /> + j 15.fillemiational Shipments I ort to U.S. ❑ <br /> I— mp Export from U.S. Port of entry/exit: <br /> = <br /> Transporter Signature bre orts only): Date leaving U.S.: <br /> W 16.Transporter Acknowledgment of Receipt of Materials <br /> Transposer 1 Printed/Typed Name Siglure Month Day Year <br /> N / ' O <br /> zTransporter 2 Pdnted/Typed Name Si g Month Day Year <br /> F E <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space <br /> r ❑Quantity ❑Type ❑Residue ❑Partial Re:ect*n ❑Full Rejection <br /> it <br /> Manlest Reference Number: <br /> F 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> a FacIlry's Phone: <br /> w 17c.Signature of Alternate Facility(or Generator) <br /> a Month Day Year r. <br /> z }} <br /> GI � Nt`t;. 1•Rt•-.ir•:'•�'i 1r. ,.'.'.•,., <br /> + 18.Designated Facility Owner or Operator.Certification of receipt of materiels covered by the manifest except as noted In hem 17a <br /> Pdnted/Typed Name Signature Month Day Year <br /> OF-SIGN4TF01 FACILITYTO GENERATOR <br /> £00IR SH'IVS XNVUHHAIH NOINDOZS NVD'IIS IC96 99t 60Z YVA RZ:ST 900Z/T1/r'0 <br />