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0729/2019 12:38 (FAX) P,003/0% <br /> lu.. <br /> Please print or type. �I.Farm=.R iro�.,Oh!(3`[�(R..2�54 on <br /> UNIFORM NAZAR[}OUS Gana l�N 61aL 2 P§ge I:vf° 3+. tN�de Pham 4,ftanifoatTraakilrg ahl or <br /> WASTg MANIRST 6 01 I <br /> JA <br /> 55•G I JIN SUPPUES 13enerat s ileAddresspGtllt(ere rarsmaVingaddiasa; <br /> 4202 dIBRALTER <br /> STOCKTON,CA 85206 <br /> 11 <br /> Genemles Phone, 963 its <br /> 8:TV <br /> Fv.1 b pr n ,Re. UA�PS�� 419 <br /> 7T as a Mar 2 Company Name US.EPA€D'N, or <br /> 8,pl3I �. U,EP I <br /> 1620 E.S RUNPA05 Ltf <br /> 13AKERSFIELD,CA 93507 <br /> vadit ee Phone, <br /> 9a. 9b,V.S.DOT Descdplfar(Indu ft Proper Shipping Man,Haaard Cuss,ID Number 1,0.Cantelifers 41)Tow 1Z11nit.° {9r tNa�e Codes <br /> MM end packing Group(f a€y)) No.. Type 0ontlfy 4hfili(a�.,, <br /> X 1• NON RGRk I AZJARD?U�WAM SO 1D (ally iWorbero DIV! � <br /> Q w' <br /> w <br /> 2 <br /> 3. <br /> 4. <br /> i4.5paaEalM 1nslrucltansandAddtlonaflnbmraHors <br /> ERG 0171 INVOICEV ���O ��1� PROFIL 9 <br /> WEAR GLOVES <br /> •���@�-lit'-�3�- !��' <br /> K eENERATOfr$/QFPEROR'8 CERTIF#CATION;I herebytadere,that the wntent§'dl this oonsJgni�nnfare fully-and aowrataly des crltied'above by.Ihe prapar sa opNtg name,aM are slasaf€re,pass ed, <br /> marked and taboledlplacarded,and are in ak reapeats ire proper wndidon for iranSparf:uccarding to applicable Womaronaland national gavemm atragulaElana:!€expotfahEpmanlond l'am the prlmaia <br /> Exporter,I cattily that lira oontonM of Otis axrslgnmenl contorm to the terms of the adachad EPAA knowladgmenkfco6elll, <br /> I aorltfy tW the WasteminlmixaUon statement idongfied 1n 40 CFR 282.27(s}of 14M a large quariU,py gsneratai)at aIn e l qugdty genatalor I <br /> Ganerataesi08am tedrrypedName Slgnatvr Qay ,f,_., <br /> _r 6.fnlamatlonal Shfpmenta ❑fm d to us. ❑ - <br /> pa pscpott U:S. Pod at err#ryla+Ut: <br /> Tratlsporkar signature(for exports only): <br /> 17.Transpmtar•Acknowfedgmenk of Recelpt of MaIwWls <br /> Tran,"L7�Pr� Name Son pt year <br /> Tran ar Pr to yped oma Signature Mcrtlhy yp <br /> fw o-t -t.-I, :1 <br /> 18.dlsoAparcy <br /> 16a. Span ❑OuanUry ❑'typo ❑Residue i _l Pedtal Rajecgo-n ❑fro.-to odoh <br /> ManifeslRefarencaNumbar. <br /> 18b,Altemale Fw@ gy(or Generaler) t]S,EPA,ID.Nt drrhef <br /> W FacgWs Phone: <br /> QI8c.5lgnatumofAttemalsFacftlty orQmralor) nnUs Day 04 <br /> z <br /> .is.Haxardwr Waele Ropod Managemelil Method Codas r odeafor hazardous wale trog4lenk d(spiisaf,acrd recydirig syafems) <br /> 4:Dosignatad Faofltty Avmeror Operator.Caruficauenof recelpl of hazardous materials covered by Iha manifest except as f1dad fn,ltem 18e <br /> P=InfedlTypedName 5lgnature I; ay Year <br /> I"PA Fvrm 87Aa2 {Rev.12.17) Pre sous edflions are ohsoleta, DE510N ACILIT- F 1?E!'5:9•IIA1�1Fi"S.T SYS1' ` <br />