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02/06/2007 10:24 FAX <br />.;e <br />Please print or type. (Form designed for use on elite (12 -pitch) Ncewriter.) <br />VALERO ENERGY <br />•i <br />IM 004/006 <br />us edition <br />editions <br />roan Approved. UMS No. 2050-0039 <br />UNIFORM HAIAROOUS 1. Generator ID Number 2. Page 1 of 3. Emegerwy Response Phone 4. Manlhfsstt Tracking Number <br />WAS MANIFEST `A� GUU ,✓`� .1`) �� �i'!�� 9 JJK <br />5. Norm and Ma tggtldfess Genmarors Site Address (11 airierent than malls g address) <br />}✓C( <br />('9'�SJ"rpF4- F <br />o.kzLf(�.a3a3G y?G!�/ /Yiu;; ;F�1 <br />x(t�s t? <br />Ge PWrle: s - 3:,?: i in C.I -IF c%i '^C' -f <br />B Tran r, en erpe <br />U.S. FPA ID Number <br />�OY1 ! <br />.'`" y <br />✓G' •� ,y i,.! J �-, 1 l <br />Tmnspxre�(( r" ,i'' U.S. EPA ID Number <br />I <br />J� <br />( U.S. EPA ID Number <br />R4'r <br />Facr' <br />s hone: — r Flt ^ <br />ea. <br />9D: U.S. DOT Description (Including Roper Shipping Name, Hazard Class, 10 Number, <br />10. Containers <br />11. TOW12. <br />Unit <br />.322 <br />HM <br />end Padwg Group (d any)) <br />Quantity <br />WWd. <br />13. Waste Codes <br />No. <br />type <br />CFM}. OST 4i c+s L(J_ry $Yh ,G /, G, <br />C Sdr�/��b Y5 /ass Prod�cl. /', ,'l.:,n\ <br />' <br />ao <br />Sl2 <br />aG l <br />HT1 <br />(� <br />z <br />z. <br />w <br />3. <br />4. <br />14. Special HarmingI and AGditlonal lnlonnation . <br />li!PQ r l'0/'G (l ✓°r L lc.v`��.' �G i/L✓�// ci /�P i %, �f Oilr� L` /Ili'h.c.f J /4 X1N.adTP <br />. [7r:o . <br />15. GENERATOR'S/OF ROWS CERTIFICATION: I hereby declare that the contents w N6 gnment am fu8 d aco F,t -y described above by the proper shipphg name, anJdasetfied, packaged, <br />marked and Iathelediplaarded, and am in at respects in paper 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 contems of this consignment conform to the terns of the affected EPAAck vuredgment of Corsair. <br />I certify that the waste minimization statement Identified in 40 CFR 262.27(a) (d I am a large quantity generator) or (b) (dl aryl a small quantity generator) is hue. <br />toesl08emrs Prid d?yped Name Sgnawle. Month Day Year <br />��-i. A -11a �< r �"rve_'+j.L ..___._.—.._^._..___. . <br />J <br />16. Intematonal Shipments ❑Importlo US. ❑Fsport hart U.S. Pat olentty/.S <br />TrenspoMr signature (M exports onty): beta leaving U.S..; .. <br />17.TmsponterAcknowledg tafReceiptofMatenals / <br />T �I Rouedrtyped No / / -- SIg �' . Month Day. . YearIMI.. <br />rn <br />`-- <br />sponer 2 PtintedlTyped Name Nigralum Mont Day Year <br />H <br />le. Discrepancy <br />18a. Discrepancy Indication Space ❑ Ouan6ty ❑ Type ❑ Residue ❑ Pamal Rejection ❑ Full R*ctlon <br />Manaest Reference Nurner. <br />18o Atemate Facility for Generator) U.S. EPA ID Number <br />V <br />Fadihy's Phone: <br />W <br />W-Sfilnature ofAltemate Facility, for Generator) Monty DaY Year <br />Q <br />2 <br />19. <br />Hazardous Waste Report Managerreal Method Codes (i.e., Codes for h <br />OUS waste treatment, disposal, and recycling systems) <br />1. <br />2' 3. 4. <br />i/ r <br />20. <br />I <br />Desgnaled Facility Owmer or Operator. Certification of receipt of hatamous materials covered by the Menest except as Wed in Item 18a <br />e <br />PnnteMYPed <br />lyp Name , signature Month Day Year <br />i <br />'Pe corm <br />8700.22 (Rev 3-051 Prevlo b <br />soete. DESIGNATED FACILITY TO GENERATOR <br />