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May 15 07 02:OOP Julie Huber 209-668-3880 p,2
<br /> P1°asa print or hpe.(Form designed for use on e~jte(12-Pitch)ttyperww Tiler.) Form App�vad.OMB No.2050-0039
<br /> UNIFORM HAZARDOUS 1•Generalor 10 Number 2.Page 1 of 3.Emergent Res onto Phone 1!000555094 - FLE
<br /> anifest Tracking Number
<br /> .WASTEMANIFEST f; r -} , , �� cI r �sFy
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<br /> Transporter:a,•�y Name _ U.S.FPA 10 Winaber
<br /> e.Designated Facility Name and-11*A4drets U.S.EPA t7 Nxnrber :r
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<br /> ga 9:1.U.S.DG-Resoi$on(mduding Proper Shipping Name,Hazew Cl4q,lU Nrmbert�,;_ ,;;';.4::: :;r: :..,...IO.Cgntainers::;.` .: .::11,Total.. . .12.lJrtt:
<br /> HM and Pacing Group(9 any)) : No. Type CuanlRy Wt1Vo, 13.'Masle Codes
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<br /> 14.Special Handling Inmetions sed Rddir ono!information r
<br /> 15. GENEPATOWWFFEROR'S CERTIFICATION: I hereby declare That the contents cthis con ent are fully and 41=jrate r desc"atave by the Prcper shimming name;and ate classified,packaged,
<br /> marked and lebefedlplacafded,and are in all respect in proper condition for bansparl accord .t. PW icable international and naTranafyovammenlal regulaGdts If export shfpmanl and t arh the Prbmeiry.
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<br /> Exporter,I cgl*that the&Ments oflhls consignment conform ID the teens of 91e atleched•f: rotledgment of Consent.
<br /> I cerdfy that tl10 waste nlintrn zetion statement kranlffied in#D CFR 252.27(a)(if I am a large a„a.1 'eireratorl or(b)(T I am a small quantity venerator)is titre:-
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<br /> ❑Impart to U.S. LJ E' ort from U.S.. Port at ertry7ea�
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<br /> Transpairlar si tura`for erdanc asci r
<br /> :::,� Dete.eavin U.S.:•.
<br /> W 17.Trensporlar Admowladgmumt of Receipt pj Materials
<br /> TranspxW I Prfntea!Typed Name gnalure
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<br /> 18-Discrepancy.
<br /> 18a.Uscreparrcy Indication Space ❑ 4uantlty ❑Type.. ❑Residue ❑Parcel Rsje:tion ❑Puff Rejecion
<br /> Manifest Referenca Number:
<br /> 18b.Aflemate Faciity(or Ganeratori U.S.EPA ID Numbet
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<br /> LL'ydt Irk.Signalve of Alternate Facility(or Generator) Monte Day Year
<br /> lig.Hazardous Waste Report Management Method Codes(i.e.,codes for hazado s waste treatment,ds I,and reuydkg systems)
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<br /> 20.0esignatedFado Owner or Operator,Cerb7rcal3ai of rsoeipt hazardoys materials covered by the manitesl except as noted in 11em'tea,
<br /> Print"Typed Name `i•' 1� / • , '. .. 51Lure � =r.•:'�4ffi._ Month Aay Year i
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<br /> EPA Farre 8700-22(Rev-3.05) Previous ediiions are obsolete. TRANSPORTER'S COPY
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