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Please print or (Form,dasigned for use on elite(12-pit«...,-.ypewr1ter.). ,-_;. ..Form Approved.OMB No.20SH039 <br /> UNIFORM HAZARDOUS 1 Generalor.ID Number 2.Page 1 of 3.Emergency Response Phare 4 Oapl�"Trediting Number <br /> (+.p <br /> B <br /> WASTE MANIFEST G <br /> Gyrator's Name and Malting Address Generalor s Site Address(d tdferent bran cru ding a s <br /> T LOGISTIt8,4WEWAN) <br /> 1 WF:S7 SCHIJIL E RD. <br /> TRACY,CA'06377 <br /> GeruraoraPhone :ti <br /> 6.7ransporter_1'Company Name U.S.EPA ID Number <br /> SHOP H4kMDS lOi..i!'TIMS,INC CAODOD646497 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Desgnaled FaciSy Nerrre and Site Address U.S.EPA ID Number Gf3 �I <br /> 65Nt d-CORDOVA,U.C. <br /> : .-RAPIM CMDOVA,CA 96743 <br /> Fadgty's Phare: <br /> IIFy-QAfl : <br /> ger 9b:U.S.DOT Descrym(Incl d'arg Proper Shipping Name,Hazard Class,Id Nurgbet:... 10.Containers 11.Total 12.Unit <br /> .. 13.Waste Codes <br /> HM and Pacldng Group")_ Type Type , Quantity WUVoI. <br /> 1. ahi +RCFthrDCHM WAB 6E i3Q. D .:.: . ;q DM.. 56 .G- <br /> 16MMOTOR M <br /> ul <br /> z 2:, <br /> ...._ .I. ..iS':.. 'i. .. .. .. <br /> 3. <br /> J 1 <br /> f Special Handling Instructions ext <br /> ATE ,. '#E��VE r Jnr <br /> 5 ,1 ,.> v,.«• . . . . .. EMBMENCY CONTACT:CHWTINE S LVA 1 , <br /> 15 ;GENERATE S/OFFEROR'S CERTiFlCjl i::l hersbl,declare that the cprrtems of dris caisigrmnent era fully and accurately a ve by 4tre proper shippng deme;aril a dasafiad, <br /> ardf�bela end aeatr respects in proper clxbi0on fir,transport acxxxalng to a{Trfxorble international national nanerMl regulagars,it expel shipment and 1 am the Primary <br /> ( ilmit tlu mnf$nf3 d>f Itds dbfui�rmeat dxmfoni to the'terins of alts attaiihed EPA �rt�d "Con' ` <br /> y l Y wasia s tanent kori ififiad til 40 CFR 28227(a)(fF f alrr a digs dN�alY generatdi4 or(tii(91 am a mn cuan6l Vnerator)is Ude <br /> Monlh, "Day 'Year <br /> Ale <br /> 16_'Intem6tilda151t1prrerds : ___ _ r.ts • ::,. <br /> r� R .,-. 0 import o U.S. 0 Export Uan U.S. Pat at entryf resp' : <br /> Tran$porfer signa6ure(for exports ady). _ ." Date leaving U.S.: : <br /> w 17_Traialpa(er oftk6o*orw6rials: <br /> 1 :. Nems _ o DYear <br /> Cr TranWbW <br /> Af <br /> Signatute <br /> z Tra r2PimteiYf Name Sgnature Month Day Year <br /> 18a:Drsaepancy hr�catiorr Space 0 Res , <br /> Ovanbty ` ❑Type dtar PaBal Rgectan 0 Fug Rejection <br /> Mardest Reference Number <br /> ' ISb.Altematefaafity(oGenerator) U.S.EPA ID Number <br /> L .. - <br /> IaL, F"Ity'sPhone: .-.. .. :::r.:• ._.. .... - ..;. <br /> LU 18c.5igriatura of Alternate Facility(or Generale) _. month Day t Yeaz <br /> s a __i_ <br /> 1.Hazardous Waste Report MerMement Method Codes(.e.,codes for hazardous waste treatment.disposal,and recycling systems) <br /> Notice:New federal form. State of <br /> ::. California requires generator to Photocopy <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as rwted in Item 18, and mall to DTSC Within 30 days: <br /> PrirfladlTyped Name signature P.O.Box 400,Sacramento,CA 95812-0400 <br /> -EPA Fvvn 8700-22(Rev.3-05) Previous editions are obsolete. <br /> r2CAIC0ATnCVQ INM A I f_nDV <br />