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D <br />Please print or type. (Form desirined for use on elite (112-oilchl tvaevveltAr.1 <br />E <br />P— A—.4 nhAn tin )Arn-nnao <br />rrIN rVU11 GIUU-44 lRev-3-05) Previous editions are oosoiaie. DESIGNATED FACILITY TO DESTUIATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />y Response Phone 41. <br />ManifestTracking Number <br />- WASTE MANIFEST <br />CAD 8 2348930 <br />D) 42-1-9300 <br />7 <br />014054360 JJK <br />S. Gene — <br />Generators Site Address (if different than mailing address) <br />123 W SONORA STREET <br />STOCKTON CA 95203 <br />Generators Phone: 209 466-9704 <br />6. Transco U.S.EPAIDRw4er <br />AeRVRORONM ENTAL SERVICES <br />CAD028277036 <br />-- — <br />Y.I.T.- <br />ransportof 2 Company Name U.S. EPA TO Number <br />8, besignit—Fi­—U,S. EPA ID Number <br />EVOQOUANlWrXT"E'R"Y"EC'gNOLOGIES LLC - <br />5375 SOUTH BOYLE AVENUE <br />LOS ANGELES CA 90058 CAD097030993 <br />Facills Phone: (323)277-1500 <br />ga, <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Contall am <br />11, Total <br />12. Unit <br />HM <br />and Packing Group (If any)) <br />Quantity <br />WtNol. <br />13, Waste Codes <br />No. <br />Type <br />� <br />t. O -CRA HAZARDOUS WASTE, SOLID {OiLYSOLIDS) <br />� <br />352 <br />D NJ <br />Z <br />UJ <br />21 rR FirTErm) <br />352 <br />(D <br />3 <br />D N <br />P <br />-- <br />3. <br />4. <br />14.SpecialHandling Instructions and Additionalikon <br />EMERGENCY CONTACT: CHEMTREC 1-800-424-9300 NAERGO 961: 171, 982: 111 PROFILE8 4/043 <br />Iff 9 1: AP20051 <br />SOLIDS, 9B2: AP203524 PAINT BOOTH FILTERS APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br />A( dn&✓C �31 <br />15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately dAcribad above by the proper shipping name, and are clessified, packaged, <br />marked and labeled/placarded, and are In all respects In proper condition for transport according to applicable International and national governmental regulations. If export shipment and I am the Primary <br />Exporter, I codify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br />I certify that the waste minimization statement Identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (11 am a small quantity generator) Is two. <br />Tenerator's/Offeroes PriintedlTyped Name Sitinalum Month - Day Year <br />A—/ <br />—_JTT <br />X41zc-- <br />r-- <br />inlernalional-SwIlimonts <br />0 Import to U.S. FlExport from U.S. Port of enbvle)dt: <br />R� <br />Transpuder sigrmtum (for exports only): Date leaving U.S.: <br />Ce <br />UJ <br />17. TransporterAcknowledgment of Receipt of Materials <br />12 <br />Trans"r 1 Panled/Typod Name Signature Month Day Year <br />�14 <br />0 <br />0- <br />U) <br />E& <br />Qspo �V�fintedrryped <br />ra —1 " , , - - ------ - - ----- <br />or Name " —Signature Month Day Year <br />18. Discrepancy <br />18a. Discrepancy Indication Space 001u.nfityt Type Residue ❑Partial Rejection ❑ Full Rjecthn <br />18b, Alternate Focality (or elsarator) U.$EPA ID Number <br />L) <br />DEC <br />UJ. <br />F– <br />FacilliVs Phone: <br />Signature of Alternate Facility (or Generator) Month Do Year <br />ENTAL ii- <br />1_( <br />19. Hazardous Waste Report Management Method Codas 0.9., codes for hazardous waste treatment disposal, and recycling systems) <br />De5pliled F the If <br />4ictify Owner or Operator: Certification of materials covered by mane ox s noted in Item 18a <br />L20. <br />l <br />prin m "aturq/ Month Day 1701 <br />rrIN rVU11 GIUU-44 lRev-3-05) Previous editions are oosoiaie. DESIGNATED FACILITY TO DESTUIATION STATE (IF REQUIRED) <br />