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ORDER i 452099 <br /> NON-HAZARDOUS 1 Generates ID Number 2.Page 1 of 3.Emergency Response Phone 4.WWe Tracking Number <br /> WASTE MANIFEST C _ _ <br /> SON--A nonnn7n <br /> 5.Generators Name and Mailing Address Generator's Site Address(i different than maiing address) <br /> SILGAN CONTAINER CORP. <br /> 1815 NAVY DRIVE <br /> STOCKTON, CA 95206 <br /> Generators Phone: <br /> 6.Transporter 1 Company Name 6 U.S.EPA ID Number <br /> UNIVAR USA INC. <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> MXI MAUMEE EXPRESS INC IN J D 9 8 6 6 0 7 3 8 0 <br /> 8.Designated Facility Name and Site Address U S.EPA ID Number <br /> VEOLIA ES TECH SOLUTIONS <br /> 5736 REST JEFFERSON ST. <br /> PHOENIX, AZ 85043 <br /> Faci s Phare: A Z 0 0 0 0 3 3 7 3 6 0 <br /> _ _ <br /> 9a' 9b.U.S.DOT Description 10.Containers 11.Total 12.Unci <br /> HM No. Type Quantity Wt1Vol. <br /> ¢ 1UNI� VER4AT. WA4YTF - ELECTRONIC SCRAP <br /> o <br /> a D M 300 <br /> W <br /> z <br /> W 2 <br /> 0 <br /> 3. <br /> 4. <br /> 13. Special Handling Instructions 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'S/OFFERORS CERTIFICATION:I hereby declare that the contents of this axsignment are fully and accurately desated above by the proper shipping name,and are ciassff-w,packaged, <br /> marked and labelled/placarded,and are in all respects in proper condrtion for transport according to applicable international and national governmental regulations. <br /> Generatoes/Olferoes Printed/Typed Name r Signa Month Day Year <br /> �M 1(—C i /-> O( <br /> .j 15.International Shipments <br /> j- 1:1 Import to U.S. ❑Export from U.S, Pat of entry/end: <br /> Traisponer Signature ifore on <br /> ate leaving U.S.: <br /> w 16.Transporter Adgm0edgment of Receipt of Materials <br /> I"' T err 1 Printed/Typed Name S' lure mum Day Y <br /> O 1re) Z <br /> Transporter 2 Printed/Typed Name turaV Month th Day Year <br /> F <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Space Qelection ❑Full Rejection <br /> uantity ❑Type Res <br /> ❑ idue ❑Partial R <br /> Manifest Reference Number. <br /> r 17b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> LL Facility's Phone: <br /> w 17c.Signature of Altemate Facility(a Generator) <br /> F Month Day Yew <br /> �� ;�'i ''� - � r'�`as'iy; X':' .ff'-.�..r<' r�J,:`i•':-ice ~t�`�''; <br /> 18.Designated Facility Owner or Operator:Cwfflc M of mcdplt of mdelkle aWMW by In eynMest except as noted in Iteral 178 <br /> P,ntedfyped Name Signature Month Day Year <br /> DESIGNATED FACILITY TO GENERATOR <br />