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I <br />FROM :STOCKTON GATEWAY 76 <br />FAX NO. :209 9464762 <br />Plea Be pent ar MV- Tdw4ned for use on elite (12•pitch) typewriter,) <br />Jul. 09 2009 02:11AM P2 <br />Cr'SrVrRtpryy'CL{RGY. wJ1 r{CYIUIlSeufucnpareUU6Ulr3t9, GENERATOR'S INITIAL COPY <br />u,,,, wpumy. wMP 1Yu, 4vuv! wa <br />UNIFORM HAZARDOUS t. ne r tD Num 2. Page 1 of 3. Emergency Response Poona 14, MMYom racktn�g Nuffdw e <br />'7"t+V r" 4/r- <br />WASTE MANIFEST f ' ^ <br />CwwaWs Sita Address (idifr6iffMan maltihg addraSS) <br />Gcrt+Tdtues Phone: C, <br />6. Transporter t Name U,S. EPA ID Number <br />7. Tran Ower 2 Company Na me U.S, EPA 1D Number <br />B_ gnatad Fadtity Name ,Vw"Address V,S. EPA ID Number <br />t• <br />faliS#yS�tWr1C'�6r. �tf L1r r ,'E :.t a V I <br />9a. 9b. U.S. DOT Dasaipfion (mrdWg Proper Shipping Nems, Hazard Clens, ID Number, 10. Contairrars 11. Total V. Unit <br />HM andPackinyGroup (if any)) No. type Quantity YrilVol. 13. Waste Codes <br />1.�.J,ti. I �, ,. r: S::E•J1./ ..;i...!.r •:C. �. t'�(f/�Atllr; <br />'rfr.' <br />i <br />2. <br />Uj <br />3. <br />4. <br />14. Special Handling instructions. and Addionel Information <br />%. GENERATOR'S/OFFEROR'S CIETIFICAT10N; I hereby declare that the contents of this consignment are fuly and aoamd ly described above by the proper stepping name. and are dassifiad, packaged. <br />ffiw 1 aril lair uNplacaded, and are in all respaas in proper condition for transW according toaDocable International aro national governmental regulations. R e at shq ivM and Jam 1ha Primary <br />exixx tv, I ctrury tnai the Contents of this cortaigwent conform to me terms of the adadted EPAAdtnawladgmsrrt of Consent. <br />I wrfify that the waste minimization SMemerd idem&Aed in 40 CFR 282X(o) (if I am a large pwantrty generator) or (b) (ii 1 am a small rin wwv generator) is true. <br />-anerawSlo k.' w" Printed/Typed Name te, r y ear <br />J <br />16. Intomaiio nal Shipments�-^-� <br />❑ Import <br />F•• <br />= <br />to U.S. I-1 E{� w from U.S. PoA of enirytaxil: <br />.Tr'an r • aUaeor o Date 19avin U.S.: <br />W <br />17.Trarn�urtertk of Receipt ofm�rrittig <br />I. <br />rsvnspnner f Pdnterlrrya �1 Narrrc ue ear <br />Ck- <br />rn <br />—Nwm bay <br />Transporter 2 NROTypad Signa"s Yew <br />18. Diweparcy <br />I ft Discrapancy Indication Sparc ❑ Que"tay ❑ Type ❑ Rem ❑ Path Rejection lJ Full R*c5m <br />Manliest Refer Number: <br />18o Aftma a Facif ty (or Generator) U.S. EPA ID Number <br />J <br />v <br />Faulit s Plrone: <br />t&:,SigrtaumaofAltemakrFanrfr'ty(orGanerstm) Montt Day Year <br />19. Hazardous W ASIr Report Management Method Codes Qs„ codes for hazardous waste treatment, daposel, end rac}aling systems) <br />® <br />f. <br />2. 3. <br />4. <br />20. Designstsd fadmry Owner ar Operator. Cenificstton � n:cetpt of trasardous matenals covered DY the maniAs3t enrixpl aS oDfed in Jtem 18e <br />Printed/Typed Name 9rgaature Month y veer <br />Cr'SrVrRtpryy'CL{RGY. wJ1 r{CYIUIlSeufucnpareUU6Ulr3t9, GENERATOR'S INITIAL COPY <br />