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MW <br /> Please print or type.{Form designed for use on elite(12-pl(di)t writer.) Form Approved OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone4.tlisrtkd Tiracking <br /> WASTE MANIFEST r 011925465 FLE <br /> 5 Generalo�Narno ar Mika rens Gsnerstor Sr e s r i.emn Than mailing address; ►'Eft <br /> Auffit TO KHT <br /> Manteca L1ltYiL-d Scher District (Sitm High) `wE i> HAZAQ-OUS <br /> 1700-ni;nia& St *Twklttittowl <br /> ,n.c � 95337 <br /> ransponer cwifry U.S.EPA ID Number <br /> A&Amed Chemical Transport Inc.108A ACTEfWIR® CAR000070W <br /> 7 Trarlapwsr 2 Carnpary Name U.S EPA ID Number <br /> B DesiUnaik FwAly Name and SteAddress 11.5 EPA 10 Number <br /> US Er:0I N0�r3 Inc <br /> PO Box S 1 Oil,11 Miles S Bratty NM30010000 <br /> fa 9tX,6 NV 89 r i <br /> 90. 9b•U.S.DOT Description{including Proper Shipping Name,Hazard Class,iia Number, 1 C.Ccnta rerg. <br /> HM and Padirg Group(if any)) ti.Total 12.Unit 13.Waste Codas <br /> No. Type Quartty M.W. <br /> c NA3082,Hazardous waste,liquid,n-o.s.(Photo Silver ` OF P 0011 541 <br /> X Solution),9,PGM <br /> It <br /> W 2 <br /> r.7 <br /> 3 <br /> 14.Special"angina Instn,cilons and Addition!Information <br /> ProJeci Number 1B331� Document�: 0187434 <br /> 1)ERC3AH71; 07x137750-277 MALI-100 <br /> 15. GENERATOR'510FFEROR'S CERTIFICATION: t hereby declare that IN conlants of this consignment are fully and accurately described above by the proper shipping name,and are daWad,packaged, <br /> marked and laWedrgecarded,and are inal respecis In proper condition for baasportaccerding to applicable iota national and natonal governmental regulations.NeRport shEpm rd and f am the Primary <br /> Ezpoder.I cerin)thmi he contents of tlns consignment conform to the terms of the attached EPAAGaeavfori wn1 of Corsent. <br /> I cel t Ov mete minimizadnu lmwt Iden'f1Nd in 40 CFR 262.27(a)(t 1 am a large quentlty ganeraltx)or(b)(if I am a small quantity generator)is true. <br /> TIC—neral imrS rm' )ped a f, Ura .7y ear <br /> IG. nkmaliwulSliipi,urnts <br /> El Import to U.S. ❑Expert from U.S. Pao of enb .t .__ ......... <br /> 112aS)talar 3 nature for onl : Date leaving U.S.. <br /> W 17.TraraporlerA.cknowladgmenfofMxApl?iMatedals <br /> r r ITT —0—'f 11Vq V1 C�2 I— <br /> franalrotlar 2 PrBiwt, ypud Name Mwlb 0ey ar <br /> 18.Discrepancy <br /> 1 Ba.Discrepancy Indicalion Space A Quantity ❑Type ❑Residue ❑Parisi Rejection ❑Fug Re oclinn <br /> Manifest Reierance Nvngwr. <br /> rlih Altemate Facility(or Generator) U.S.EPA ID Number <br /> LL U <br /> I acibr's Phane: <br /> w 18c.Signature ofAfternateFacility(or Generator) Mon,h Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Repot Management Metiwd Codes(i.e.,codas for hazardous waste treatment,disposal•and recycling systems) <br /> W 1. <br /> a <br /> 20.l)esnpnalod Fadhty Owner or Operator:Cedirication of rateipl of hazardous materials covered by the manifeal sx in Ilam 18a <br /> Prinled )pad Nairne Mom41 Day Yew w\j� SM1A3n::n'— I <br /> EPA Form 8700-22(fee 05) Previous editions fe obsolete. i DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />