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L -0 Dry <br /> cnseams r .,,,1=6 0 w <br /> _ — Ul <br /> Z ry o m <br /> DForm Appmved OMB No.22�g �gU3g[[SfrQQ —{ O <br /> Please Grp"' �pgye ph a-xtanlFeal Tracxhrg Number Cn <br /> t-[w,nernux @ N4nlbm 2 Pli 11 3 ",'.R Rg`ibFs-l id <br /> D UNIFORM HAZARORUS r �Ql�xay 27:5>= � <br /> z WASTE MANIFEST Q <br /> "W,Name and Marl nQ Addn� Genemlor'�Site Aodres�{il alflerenl than mailing addrassl CD <br /> M s City Of Tracy e O 0 <br /> Pr.•de ;'vett S2A Trai k Aivd 0 <br /> D <br /> • QiQteJ-!1�•1-�'.r'0 U.5 EPAIO NumbC! Uq G <br /> C,e7e�ra�raYspgP�ro�rep� <br /> f'• fi YF��TI'- 1 LCIr $Y.�i f E:ply tE�(- O . <br /> . <br /> US EPA ID Numner 7 <br /> TrwnsprW 2CamPa'1'N"me 0 <br /> CLEAN HF7 i RS ENV Sx`L: fIW . Us EPA{a Numtrar -1i <br /> . 8DesllpmledFaedB'Nam andilAndress CLEFlN HP44-rVJRS 41HAWIll 3 <br /> 116ak) WCi;fli Ff--(115 I;nq <br /> S <br /> 4.35-BS4-91 N N <br /> v <br /> F 's Phone. 10.Conlainers t1 Tnlal t2 Unn IJ.waste Gpde <br /> ya 9b u S DOT Deco W 0-&4W Pmper Shppnn Name.Hazard(IID Number. No Type <br /> Ouanhsy WI N6 0- <br /> NAI amP.0ic4wIII anyff �; 1, 352 I C <br /> LA <br /> a t i ly,I7 r->.c wfynT a INTSI J�.: C <br /> O r Oil <br /> rn <br /> M z <br /> W <br /> EP 3 <br /> Oil <br /> M <br /> r r"F <br /> ' O <br /> O <br /> fV <br /> f=S:z_.a..ranaiir�a lnsfruCdons and Additional lnlomeaaon TSUl.F1l+ Lrl <br /> 00 <br /> ERSIN133' enerat v <br /> - .4.4 EWFZi&NCY*LW-49.9-1760--CH/SK/T71-Ci)ntra�t ri-talnrrd by 4 t:•t ,s_, ,, rn <br /> tr n^ r" <br /> RENERATOR'SrOFFEROR'S CERTIFICATION: hereby dec€are That the canlenls of IhiS consignment are talky and acourateky described aheve by the proper shipping name,arra era cVassitrea.pa�.xagec (n <br /> marherl and labeledlpka€arri and aren all respesrs In pmper condition for Imnsport according to applicable inlemabcnal and national governmental regulations-It expon shipment a,ttl I am the Primary <br /> Exporter,I Cal Ilial rhe contents o1 this censgnment conform m the lerrns of the attached EPAAci,nowledgment of C'I aorta small gvanlity generatoi)is true. <br /> {ryrlifyM the waste minim¢abon alakement identified in 30 CFR 262.27(a1(Ir I am a€arae quantity generator}or(b)li month pay Veal Qj <br /> Sign ilure - - - to <br /> Ga1er�45Nervrs Pnnted7yped Name 0 <br /> rn <br /> 75 Inlematronel$hip+nmis ❑ to U.S.Im on ❑Export from U.S. Port of enfry[exif — ID <br /> p Date leaving U.S.: G <br /> ? Tra,,4,VF,Y si vne(fnr ezpoRS onlyl� ID <br /> W <br /> 17 Tran5por�rp iedgrrlenl r f R"c"Pt Of Mall Month Day Year Q- <br /> ►- T 1 Printed�Typed Name Sgnalure <br /> f- <br /> m �r, re r+ <br /> Month Day "elf S <br /> r L Slgnafure 0 <br /> Z T+ar,prTEer 2 Pnrivd rne <br /> T eC <br /> Q rrt <br /> or <br /> 'e:.::r%'aparoCf :3Vf <br /> ❑ lal Rejection ❑Full Rejection �' <br /> Itis Dsvopeny Inmcahon Space L1Ty,,• ❑Residue Parl <br /> ❑ Ouanb y <br /> N <br /> Manifest Reference Number. � <br /> US-EPA ID Number Q <br /> rD <br /> lab.ANerclare Facil {nr Geniii i N <br /> Oq <br /> U <br /> X radrtyrs Ptlm�e Mnnlh paV Year rt <br /> LIJ • fF (a awrJ <br /> 0- <br /> o 'Sc gnawe f e <br /> 4 � <br /> [7 ig Hazari Wabe meow Codes(I e.•codes fnr hazardous waste tre8tm0nt disposal,and recycling syslems� <br /> _ d <br /> s 0 0 <br /> `� '. 0 <br /> 0 Q <br /> ql tl�JfdOUs IneWrale covered by the manileel except as Idled in Item 18a Month 4ay Year -0 3 <br /> Signature <br /> rGENERATOR'S INITIAL COPY <br /> O <br /> fy <br /> rQ Cl) <br /> (D 00 <br /> fV O <br /> 0 <br /> O <br />