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JUL-24-2008 08:13A FROM: :4683433 P.3 <br /> A. - A <br /> Form Approved,OMB No.2050-0039 <br /> Please print or type.(Form designed for use on efiite(12-pitch)typewriter) <br /> V <br /> Genarator ID NumheT 2.Page i of 3.Emergency Response Phan" 4,Manifest Tracking Number <br /> UNIFORM14AZARDOUS CALOUO2'1 3454 �012 .15"825 SKS <br /> WASTE MANIFEST i 1 1-800--468-176t? <br /> 6,Genareta>'s Name and Malang Address Generators Sita Address(if differonE than mfluing address) <br /> VILLAGE WEST .MARINA <br /> e,64E] EM ARCADER+1 Cps 14521.9 <br /> STOCKTON <br /> 209 95 — 1551 <br /> GaneratofsPhone. U.S.EPAIDNumber TX110600509 3(-' <br /> MAV <br /> U.S.EPA lD Number <br /> 7.Transporter 2 Company Name <br /> B.peSfgnatedFacPityName and Site Addrasa SAFETY–KL E14 SYSTEM–., INC. 0U0618 <br /> U.S.EPA ID Number <br /> 1722 COOPER CiREK ROM) T% '16206 <br /> DEN` ON. T]i1 OT1603371 <br /> , <br /> Fetatiy s Phone: <br /> l 11•Total 12-UM 13.Waste Codas <br /> its, 9b.U.S.DDT Dascdptkm(kLduding Proper Shipping Name,Hazard Gass,10 Number, 10.Contenam quantity Nn Not. <br /> HM and P=Wng Group(d any)) No. Type <br /> X. <br /> Z k 2•hlASTE i ( i(): COMAININiG f LAMMABLe <br /> UM P POO! F003 t�,)r71 <br /> rWa LILA11fl, N-(1. : . ( T0LtiEHEj4ETHYL �:`IWIL / / DO3` 35 +30TS <br /> RNME) 4. 1 IJN3175 PG 11 + +� <br /> 3• Sfp`nl�(��t'}�'"I'iu'C$�'41]'{y''�t9.}{v,""�(iy3�A,`r3�4'�41""�`5��'CS5""" ., . �. <br /> ( Ir1'f Ay�•i:'��AT�.1��.....+1� !"i�1i Tn f7-1riLS�..r.�ww.�r�.e .♦.raw:.v..'wirw^r'...........'�.s .nnwr�,i M:n Y+nw. .. r,w.� �_. - <br /> 4• <br /> 1 .Special Handling Instructions and Addillunal Information a K T R C K 4109'5 9 31 Ori 000 5 3?5 9 8 <br /> JK A <br /> UNIT C. RRJCEtS: 4I078 41471 81581 82'1'33 A5X99 7'H L> 'C'a USE aD�l,.SE� IIS rsht 'n nama,ardaredasslned,packaged, <br /> 15. GENERATOR'S1E]FFERt3R'S CERTIFICATION;I heresy declare that the contents of this corrslgnmonE are fully and accurately described above by the grope Pp+ 9 <br /> marked and labatadfplacarded.and are in ail respects In proper condition for transport according to applicable International and national governmental rogulallons.It export shipment and I am the Primary <br /> Exporter,I cadity that the contents of Drfs cartstgnment conform to the terms o1[ham a e aE�AAckn oc of Co I am a small quantN generator)is true. <br /> I certify that the waste minimizallon state nsrd Identified in 4D CFR 262.27(a) large R n*9 (N) Month Day Yaar <br /> GeneraiofsloRerofs Pdrttedfiypet ' <br /> d Name Slg4atura <br /> .r <br /> f ,•'. -. !i <br /> E16.fntemati l Shipments 1m ori to U.S. ❑Export from U.S.` Port of eotrylexit: <br /> p DatateavingU.S.: <br /> Transporter signature(for exports only): <br /> 17.TranaportarAcknowledgment ofReceipt ofMatedals ,.:, Month Day Year <br /> Signature <br /> Transporter t PrjntedlTyped Name ... f <br /> to <br /> Transporter FnntaculypedNorma <br /> re Month Day Year <br /> 4r <br />! 1B.Riscrepency <br /> 189,0istxmpancy Indication Space ❑ 0,muty ❑Type ❑Residue ❑Partial Re)ecUgn ❑Full Resection <br /> Manifest Reference Number. <br /> U.S-EPA fD Number <br /> 184.Alternate Facility(or Generator) <br /> r <br /> p <br /> aMonth Oay Year <br /> ra. Fadlilys Phone: <br /> aa tilt.Signator"of Alternate Faculty(or Generator) <br /> S2 19.Hazard—m a Waste Report Manageowt Method Codes(i.e.,oodles for hazardous waste treatmaot,disposal,and recycling systems) 4 <br /> � 1• 2. 9. <br /> 20.Designated Faculty Owner or Operator.Certification of receipt of hazardous materials covered by rho manirosi except as noted in ham t8a Month—Tay--r-8-1 <br /> Pdntadffyped Name Signature <br /> GENERATOR'S INTI L COPY <br /> EP F 0 R v.3 D5 Rr i s its ns ar 41 <br /> .t`�.� ����'�.�,a_�b`' .� � at>'t�Es��68Df41f14�.k5o <br />