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Sep 14 2015�y�.10:47AM HP Fa`xLaaL�d��rdTTs Marigqna�y{2094779585 page 6 <br />PT <br />Phrase drit or FDrM desi inad for use on elksitcm <br />12- <br />( )typewriter,} <br />�pF HAT?Rdt�US 1. Generaler ID Nuntbsr 2. Pape t of Fane envy Reago�se Phone <br />WASTEIIAINIFEST Cl�..ie3+bt1 64;3 1 �f-4,$ - 7+ <br />Farm Approved. OMB . 28540038 <br />4. n s a In N <br />5.Geneat36jNamaandMailingaddress <br />SKS <br />Ladd$ Marina Pstrjf.i� f4unttifieId r s <br />anrr®ifngaddrbssl <br />4911 Buckley clovit W,&Y <br />Gerreraices Dhoni 209-477-95P-1 4 2015 <br />Tran <br />TZ 1 <br />U.S. EPA ID Number <br />e - <br />y �yy� <br />TX�dai: <br />&pnfpany me <br />LICQr•ru ncr ;UA OT4ACnr� <br />U.S. EPA tO Number . <br />B: ala aY 2FreaidSlt9Rtldrew oz .S{fjy�.JOSE p ► C° <br />"'R' <br />U. S. EPA ID Number <br />i#RWhA ROAD <br />r: > SIM JME r� �Si;33 <br />'.. Meal <br />4118-441--0962 'A <br />s Phone. <br />CAD05=�'f1�.�4,31 % <br />ga• 9b: U.S. MT Desaiplon (indL ft Ptoper Shipping Nsm,, Heasrd posit, ID Number Ia. a <br />HM and.F adm9�p0any)) <br />TYPa <br />1t, Tow 12. Unit <br />13. Waste Codes <br />QUMUIy WLrVd. <br />x ' 7 <br />. s . +(LEAh' BARIW) , JN F)G I I I / <br />t' 7 NN <br />j .._... <br />C9 <br />4. <br />. Spadal Handlrog hshuttio .and Ad al I` Ormaflon <br />AP <br />_.. <br />.f <br />3Et 71.I[ Al rt #i-E#t�-4 8--9.7E, #. FETY-F{t�.F_E�(3 <br />. <br />J l <br />�. <br />f ' CiF iATClR'610FFERDR'3 CERTIFlCATIDN: ! hereby declare that the contents of fir, consignment are My and accurate!) deecribed above by the,propershQFing name, and are classified, packaged <br />rferk9d �tglabe edlplecarded, and a e in all respects in proper condition for transport acoordng to <br />: <br />applicable,intematimal and natbnai govemmenial regulations. It export shipment and I ST the Primary <br />Expert, l eerwy that the contents of this con*nrnentconform to the terms OF the attached EPA Acknowledgrjrent of Consent <br />tcQ* b>af!he waste mindmization statement IdaAW I0.40 CFR 262.27(a) (if I am a large quam4y generator) or (b (if I am a small quantity generator) is true, <br />i�alwrtoP r& PrinbedPlypid Nome Stgnabtrei <br />tAonlh Day. Year <br />17 -r <br />f�; q Br1e <br />hrrpprtto U.S. Ez!?pt hnm U 5 = pog of ent yla t <br />W511 K@r rfatttre (for exports ordyj, <br />: w <br />— <br />Date IeaY U.&: + <br />'tf�.?RaV�igrl9rA�knowledgmsM of#teCefpt of l�Aat�ials' <br />Tdin yped Nam Sign r ` <br />Month Year. <br />rd + P it1Wd d rime <br />Nonth Day <br />18:Llsctepancy <br />: <br />? <br />188. Discrepancy Irtdiration Space l�^^�-� <br />❑ Quantlly Type E Rewus <br />�•-� <br />n Parpaf ReJ"- ❑ FuU <br />Rejection <br />I Alternate Facility jar Generabr) Ce Nunter <br />G'e? <br />U.S. EPA ID Number <br />FwMVs Phone: <br />Irt Signature ofAltemete Facility (or Gererator) <br />Month ay Year <br />; <br />1g;.Haaardotal"Ye Raport Management Method Codes (i.e., codes for hazardous. <br />f�1 <br />waste treatment, disposal and recyding systema i <br />2. <br />' <br />Q:) <br />3. <br />t: a <br />4. <br />t <br />i <br />?O:Qeaign l Fa¢plt 'DiNnieror Dpe. rator Carti';Gation of receipt of'haIDrdous trt�B[lalb coveted byilio lrtalliteal. <br />... except as <br />E~ ettfl 8700- 385. o4 editions re obeole)e. P DESIGNATE D FAC <br />11, TO GEA RATOR <br />