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714 <br />Form Annrnvnd OMR Nrl2050-003q <br />W'A 1-Drm atuu-zz tKev. J L2 rravlVu5 "u T"' <br />vw�..•,..� • • •,�•- - -- - - - <br />1 ) If- 00203/1_'2, t/F,-/J1 <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />cALv�m�,._,go61 � <br />2. Psig 1 of <br />1 <br />3 Er�gr egcy Resy nse Phone <br />f'-r.f�Yl- 4E,�- 17F¢I <br />4. Manifest Tracking Number <br />1002952770 SKS <br />WASTE MANIFEST <br />5. Generator's Name and Mailing Address enrols Site Adgps (itdifferent than mailing address) <br />RYDER T/;3 1071 s <br />3633 Duck Creek Dr <br />Stnr_liton CA MF15•-795 <br />Generator's Phone: 209—C143 ic-' 1 E) <br />e H U.S. EPA ID Number 1_ r <br />" SY8 fEMS, INCK TX R¢u7�¢nll,f7,l�W¢f <br />7. Tosportsr4-GompanyName EIVVIRONI�IIE�IT LEPAIDNunmber <br />8. Designated Facility Name and Site Address �3AFf: rv- Kl_.E:.I::N sv�;T)::r�s INC. _ U:14, jlO Number j <br />WID <br />1.7C�1� r..E�nn)-:R cRE►% R <br />940-483-52 _00 TXD0776K371 <br />Facilites Phone: ' ; <br />ga <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Coaes <br />No.Type <br />HMIand <br />Packing Group (it any)) <br />Quantity <br />Wt./Vol. <br />X <br />1. RIP UN2791f WASTE BATTERIES, WET FILLEDDF <br />WITH ACID (LEADS SULFURIC ACID, <br />r <br />I'= <br />I)U�¢1� <br />Dt��b�� <br />1F3.�;I.: <br />o <br />q� <br />H, ('G III, <br />l�(.il Ei <br />w <br />2. <br />3. <br />4. <br />14. Special Handling Instructions and Additional Information SK •• IA I P#2 05905571 X674271214 7526583 CSG - <br />1) ERG# 1 a4 <br />24 HR EMEf6ENCY U-800-468-17612""'WEr LEEN - CONTRACT #941:38) <br />,.,..., 8,-2 , <br />SK AUTH' D TO [ME SUBIiEQUENT CARE IER9:4107�t 41 ,e 9 K <br />15. GEN ERATOR'SIOFFEROR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, p2.Ckaged, <br />for transport according to applicable Internationaland national governmental regulations. If export shipment and I am the Primary <br />marked and labeled/placarded, and are in all respects in proper condition <br />Exporter, I certify that the contents c&hIs consignment conform to the farms of the attached EPAAcknowledgment of Consent. <br />I Corti t the waste Nmlzall a ent Identifien 40 CFR 262.27(a) (If I am a large quantity generator) or (b) (if I am a s all quantity generator is true. <br />Si nature Month Day Ye2C i <br />'n g <br />Generator's He ame <br />-191niernational Wmats ❑Export from S. Port of enlrylexll: <br />❑ Import to U.S. <br />Z <br />Transporter signature (for exports only): Date leaving U.S <br />w <br />17. Transporter Acknowledgment of Receipt of Materials <br />Manlh Day <br />0 <br />Z <br />Trans er 2 PrrintedfTyped Name 00-1 ature Month Day Year', <br />18. Discrepancy r <br />rr�� <br />18s. Discrepancy Indication Space quantity ❑Type ❑Res due l ] Partial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />18b, Alternate Facility (or Generator) U.S. EPA ID Number <br />J_ <br />V <br />U- <br />Facility's Phone: Month Day Year <br />LOU <br />18c. Signature of Alternate Facility (or Generator) <br />Z <br />N19. <br />Hazardous Wasle R port Management Method Codes (i.e.. codes for hazardous waste treatment, disposal, and recycling systems) <br />LU LU <br />1. 2 3. 4. <br />L.� <br />2 . Designated Facility Owner or Operal.: Certification of receipt of hazardous materials covered by the Yest except as noted In Item 188 <br />Ya <br />Pn I Ty Name ature Tth (ay <br />1-[ rllklAT1r1Pl CTATC 11C CCr%l 1101=r11 <br />W'A 1-Drm atuu-zz tKev. J L2 rravlVu5 "u T"' <br />vw�..•,..� • • •,�•- - -- - - - <br />1 ) If- 00203/1_'2, t/F,-/J1 <br />