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RECEIVED APR 8p� �f <br /> t -*9 <br /> Please print or pe. orm designed for use on elite(12-pitch) ,,.vvhter.) 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 CAD097 1• - 46(> 001450204 G B F <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> SUMDEN WIRE PRODUCTS,CORP <br /> `1412 EL PINAL DR <br /> STOC:KTON,CA 9520 <br /> Generator's Phone- <br /> 6.6.Transporter 1 Compaate U.S.EPA ID Number <br /> SHOP HAZARDS SOLUTIONS,INC CA0000846497 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> GEM-RANCHO CORDOVA,L.L.C. CAD980894193 <br /> 11855 WHTE ROCK RD. <br /> RANCHO CORDOVA,CA 95742 <br /> Facility's Phone: 916-351-0£) <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1 WASTE AEROSOLS,FLAMMABLE(each tot w ceedkV 1 L capec*V).2.1 3 DM 295 P D001 "I <br /> 0 <br /> z 2. <br /> w <br /> GEM has the appropriate <br /> 3. permits for, and will uccePt <br /> the waste this generator is <br /> 4. <br /> -I <br /> " Special Handling Instructions and Additional Information <br /> PROFILE#GR3691-01,MSC SPENT AEROSOLS <br /> APPROPRIATE PROTECTIVE CLOTHING 11 <br /> SEE ERG*126 w 3S4 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully 5nd accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the PHmary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small qua tity gen tor)is true. <br /> Generator's/Offeror's Printed/Typed Name Signature Month Day Year <br /> < � r <br /> 16.International Shipments <br /> F ❑Import to U.S. ❑Export from U.S. Port of entry xit: <br /> Transporter signature(for exports only): Date leavi U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 PH /Typed Name Signature Month Day Year <br /> a0 -.1 (i.-...." f <br /> Z Transporter 2 Printed(Typed Name Sign re Month Day Year <br /> Q <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue Partial Rejection on Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> L) <br /> LL Facility's Phone: <br /> Qw 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Y <br /> 19 rdous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> r _ r r <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO GENERATOR <br />