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07/29/2019 12:38 (FAX) P 1 003 <br /> Please pint or iype. imo , . g39 <br /> 7U8 u�erUNIFORM HAZARD <br /> =' <br /> WASTF MANIFEST JJK <br /> �t��` IEl3IiUC,SI�PPl.1E5 aeneret s iteA&ass(I4dittarent117anmsGingaddYasa) <br /> 4=WR'ALTER <br /> 'STQCKTON,CA 55206 <br /> Generator's phone: 209-5$3-ita"LJ9 <br /> U.S;EP <br /> 7,Tr ns oder 2 Company Name } 'UX.EPA IP Number ' <br /> 1620 E, BRUNDAGE Ln <br /> EA<ERSPII5W,CA 933{x7 <br /> Faalt s Phane; 661-802-am <br /> Ba. 9b,U,S,DOT Desodpifor(Including Propkrshi�ping Nana,Hazard Class;ID Number, 10,Cantetirats 11i Te1al 12,Un3t <br /> IqM and PiidMq Group¢f any)) 13.Waste C6tlea <br /> Fio., TYPe tJiranf#ly 4YtJYi+�.,. <br /> X 1. NON RCRA-KAZARDOLIS WASM SOLID (olly absorbeq) Dt P <br /> ru <br /> w 2' <br /> 0 <br /> _ 3 <br /> 4. <br /> i4.5peraafFfa NsgtnstirrctionsandAdd;€ionaflnfom>alkm <br /> INVOICE# O oPkt)l*iL�FF <br /> 15, QENERATOWSIOFPEROWGEKnPICATION:!hereby aa€sra that the conlan€saf this oanslgnrnar,)are fUly.ena i6writoly descri ed above 1:014 prapers,*pingname,cnd ora'ci ssffe$,pati sd, <br /> marked and tebelsdlplacarded,and we in all rvepeclsin proper condition for hnspor mwding to applfoable 6(irnelionsiand natlanal governmentalragula ans:IteHpart.hlpmenland.!'am tha'Primary <br /> Exporter,f cedifylhat the wntsnts of this consignment coniomti to-Iha lerms of the aiiached EPAAcknowtedgmiinloft;of:eenl, <br /> i certify Thal the Wade minkrgzaticn slaismenl ldengrled in 40 CFR 2G2,27(a)Off am a large quMkly gaasraW)r di efn:e tl quartfity gepsratot I a. <br /> Ganerafiar'sl0ftern to ypedNsme v Slg r - '.: .. .DaY , .;r <br /> �Q � <br /> 16.Intarrraganaf Shfpments <br /> El Import to US. �.Esrpo€f' U:S, Port IN snbYAW. : <br /> Trareporleraignsture(for s)po*otdy}: qe IrpyingSJ, :. <br /> 17.TrenspaierAbkvvAedgrj*M of Receipt of Materiels <br /> Trantt � Name Slang ..•Yt. pay Yet+r ; <br /> Tran Iter2 is Pr yapped Name, Signature /►�M^� }Y yY , <br /> 18, isrz pancy L V <br /> �r---ll <br /> 18a.Dfscrapaney ind cation 5paca ❑Quanttty ❑Type Residua L J Padlet ecgn <br /> RsJo ❑cul(;tiejaFtlan <br /> fslardfesl-Referenc6 Number: <br /> 18b.A#tema(a WRY(or 6aneralor) il$Ei?AID•N5rit6es' <br /> t3 , <br /> L Fac4lVaPhone, <br /> it3a.SlgnetursafAlternate acdiy arGeneratar) 7OfM DAY Yeak... <br /> i9 Hazardous Waste ReWManagemant Method Codes(fey codas for harardot a waste 7ee6link disposal,aW racy h'i;systema) <br /> 20.Csesignalad Faotllty brmer w Qporalor.C,eMTcaron ofrgcetpt of barardous materials covered by Ole mealfest ericeptaa riled InAom 18a <br /> PflowlTyped Namo r Slgnatu;e oh ay ear <br /> EPA Form 9780.22(Rev.1217) Pre sous editlonsare atisoleto, DEIGN AC1L#TY TC)EWr,.04WANIFEST.,tYSTOW <br />