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JUN 17 '10 11:33 FR STOCKTON HUB MGR 209 942 5487 TO 812094683433 P.10i18
<br /> Please print c r (Form d0c d ' ned for use on elite(120tch)typewriter.) Form Approved,OMB No.2050.0039
<br /> UNIFORM 1.Generator ID Number 2,Pa 1 of 3, e�y
<br /> HAZARDOUS ,���,:�s.•,.n•-s � 1 Rtnse,P,�ag� 4.M�fegt T[acking�rnper
<br /> WASTE MANIFEST ' *' j sa S Y ^-;a.' ,. 3 33 F 1 FL E
<br /> 5.Generator s Name an MaIMyAdpregg Generabor's SiteAddress(if different than mailing address) `I
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<br /> Generators Phone: '"fr'
<br /> cit U.S.EPA IDNumber
<br /> 7.Trenspxtar 2 Company Name U.S.EPA ID Number
<br /> 8.Designated Facility Name and Site Address ,�r'e:r_Y, ' U:S EF, Number
<br /> '�C.tiy w.'.dru_d"'�.:i r.;•Z*"..'�,LiS S�„t�r� - .,
<br /> FaCfli 's Phone:
<br /> 9a- 9b.U.S.DOT Dewption(including Proper Shipping Name,Hazard Class,ID Number, '�.Conta vers 11,1bg1 12.Unit
<br /> t1M and Packing Group(if any)) No. Type Ouim* 1yt,Alp11 13.Waste Codes
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<br /> WIN •:, %!1 = t '1f%.7 ,-STE,z:3ff= -.kl
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<br /> 14.Special Handling Instruchoes end Additions!Information
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<br /> '4�' fC:'�.L:f'7;3f C u•'r« ��}} CC 77,}S:, .a.:'.
<br /> 15. GENERATORWOFFIEROR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are furry and accurately described above by the proper shipping name,snc are classified.packaged,
<br /> marked and labeled/placarded,and are in all respects in proper condition for ir8n5W according to applicable international and national governmental regulations,4 export shipment and I am the Primary
<br /> Exporter,I certify that the contsnts of this consignment conform to the terms of the attached EPAAck n*edgment of Consent.
<br /> I cc*that the waste minimization statement identified in 40 CFR M27(a)(if I am a targe quantity generator)or(b)(If I am a small quantity generator)Is true,
<br /> erator aro S medl yped Name 14gnave month yl�r
<br /> J 18.Intemativnal`Shlpments •,, v
<br /> 0 kmponto U•S. ElExport from U.S. Pat of entrylexlC
<br /> Tran rs nature for exportsont ; Date learvina U.S.:
<br /> QC 97.TranspabarAcknowledgment of Remlpt of Materials
<br /> TtarraPorter 1 Pr<ntedfTyped Name ��. � r ignature nth- y - ear
<br /> Q Trar%s brter 2 FrInIledirryped Name " ,Month Day =05
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<br /> 18.Nscrapancy
<br /> 18a.Discrepancy Indcation Space Lj Cuantity ❑Type ❑Residue Partial Rejection C Pini Reisdion
<br /> Manifest Reference Number.
<br /> 18b.Alternaw Facility(or Generator) U.S.EPA ID Number
<br /> C3
<br /> Facili s Phone:
<br /> 18C.Signature ofAltemate Facility(or Generator) Month Day Year
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<br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,arto recycling systems)
<br /> C 1• 2. 3, 4.
<br /> 20.Designated Facility Owner or Operator,Certification of receipt of hazardous material;covered by the manifest except as noted in Item 18a
<br /> PrimedlTyped Name Signature Mcr•7t Day Year
<br /> EP,4� 12r( 4, P e4 sue Itt�of o )e� h�h`t GENET ATOR'S INITIAL COPY
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