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M <br /> CID CO <br /> CO N <br /> L _ <br /> � O <br /> O Ln <br /> rr <br /> n Redding•SmckNn•Weel Swaman l' <br /> 0 I � <br /> __,o„tal Health Departs^e Dt' � <br /> O <br /> U <br /> O Form ADPrwed.OMB No.2050-0939 — <br /> rr Please puns oI typo.(Form designed lar use an stile 112-Pllchl ly writer, 014053430 JJK -`—� <br /> a.Manllaat Tracaing Number <br /> 1.Gnnarater ID Nu;nbar g.Page 1 al 1Enwmnncy Rr:nn;vu 4'nun^ 2486 y/ <br /> UNIFORM HAZARDOUS ,. <br /> WASTE MANIFEST t• I. t"'' ..r T Garwrawrr.Strr Mdu�s al n;eammlbmr malting aaarwsl ZO�n Pb(se <br /> 5.Gen ireado 8 Name and Mating Addate: `alue�11Dnu1 <br /> WESTFRN TRUCE.CENTER <br /> :13i9S HWY 3:+ IiF;'rIJVA'r'd:d aeieyD-ry <br /> STOCNI IN3730(1 1;PN <br /> U.S.EPA IO Number... Ae01e <br /> Ganeralars Plane: -"1,-l F <br /> 6 Transporter 1 Company Name �-A U U <br /> Af,11URY FNVIRiiNN1ENfAt SERVI'. U.S.EPA ID Number <br /> 7 Trensiader2 Company Name <br /> It 5,EPA ID Nu ram <br /> 9.Designated Facility Name and Sile Addreee <br /> In. <br /> FanlShmpmg Name.HzaN Glass.ID Number, In.C.me,,ers 11.Total 12.Unit 13.Waste Godes 9D <br /> 9b-U S DOT Desaiplion nnc'ud;;'.1�'`�er <br /> NT,,, Quanllty Wt Nal <br /> ga. o. he <br /> HM and Packing Group til dnyll a <br /> t <br /> 1 CRA HAZARf. °r' <br /> 0 <br /> a <br /> w <br /> � Z <br /> �+ C <br /> C <br /> Cz <br /> :i.SPedal Hantlling lnstrucdons and Adtlitbnal lnlormalion rl <br /> N FMFFtnrNCYCONTArT CHEMTREC 1.800-4 <br /> r.�'r=^:',..iz!AT F PER`-1�IHAI_PW` <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION:Thereby declare that the contents of Nis consignmenlarefullyantlaccumtelyde iwdstove by he Draper snipping name.art are classified,packaged. <br /> marked and labeledlplawmed,sod are in all respects in proper cantlition for bansport according to aDPllrable inlernabonal and national govemmenul regulatmns.Il export shipment and l am the Primary <br /> T Erpoder.I certify that the contents of his consignment conlorm to the terms of he attached EPAAcknowledgmanr(b Consent Month Day Year S <br /> - N. <br /> ceniry that the waste minimization statemenl idetirfied In aU CFR 262.271a1(if t am a large quantity S Signature nerelort or(t)(A am 2 small quantity generator)is Inge. i <br /> T Genemlotsl08ero/s Pdnted/Typed Name S <br /> O ❑Export from U.S. Pod of entrylexit'. G <br /> U 16.International Shipments ❑Import to U.S Date leaving U.S.: 1 <br /> Transporter signature(for exports only). Month Day Year <br /> O X 17 Transporter Acknowledgment of Receipt of Mate els Signature <br /> W <br /> Transpoder 1 PdnledlTyped Name <br /> Month Day Year <br /> asn"W r= <br /> LM Z Transporter 2 Pnnled/Typed Name <br /> O Q <br /> K <br /> C 18.Discrepancy ❑partial Rejection Full Rejection <br /> ,� ❑T1,.e <br /> Residue <br /> U) <br /> 18a,Discrepancy Indication Space ❑Quantity <br /> ' Manifest Reference Number U.S.EPA ID Number <br /> 'EE <br /> � � 18b.Allemate Facility(or Generator) <br /> Q Month Day Year <br /> CO LL Facility's Phone: <br /> w 18c.Signature ql Ntemale Faqllity for Generator) <br /> It <br /> C") a <br /> CD � z <br /> O O y 19.Hazardous Waste Report Management Method Codes(i.e-codes for hazadod,waste treabnent,disposal.and recycling systems' <br /> � 1 G 1. 2. <br /> QO hlonlh Day Year <br /> U 20.Designated Facility Owner or Operator.Certification of rece'pt of hazardous materials covered by Ole m5ignalurecept as tided m Item 18a <br /> •Pruned(Palo Name <br /> GENERATOR'S INITIAL COPY <br /> E <br /> O <br /> � � EPA form 870522(Rev.3-05)Previous editions are Dbso ele, — <br /> ) -- <br /> L) 2 <br /> ZT w <br /> LO <br /> X00 0 <br /> N O U <br /> N = <br /> � � rn <br />