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L -0 CY) <br /> Zy- N cil <br /> o - Cr <br /> Z � o m <br /> G1 o -10 <br /> D <br /> D — v <br /> o Q <br /> Z SFS SHIF* o cp <br /> = Please I or Ivp e. �< O <br /> DI UNIFORM HAZA,R000S I,GeneraWr Ip Number Ott <br /> WASTE MANIFEST CAL000 2.Page11 of 3. me Farm Approved.0M13 No3CD,2:j%.5 y C <br /> 4"r`a ]-.�anfy RBspu{ysa i it 4.Moll Tracking Number <br /> 5.Generator's Name and Mailing Address td9f@�1tUU 44tr77td1�- I 00-� g 2 59 SKS <br /> City Qf Irar o <br /> Bcy de y Generators Site Address pfdifiarenr than mailing address) <br /> TRACY S�ctf^ <br /> Bl vd <br /> Generall Phone: Q19—$31--q 4 c'0 'j 95 '?h-00iAO <br /> 6.rrp;pr�Yo—KL. - tv <br /> 1iF� rt� SYSTEMS <br /> INCTWG' JS EPA Ip Numher � <br /> 7.Transpoder2Company,Name 1dF200i00+31t05 _ O- <br /> CLERN HARBORS ENV SVC INL. o <br /> U.S.EPA Vp Number 0 <br /> 8.Ueeignared Facillly Name and Site Address MADD3932?�" ` N <br /> CLEAN HARBI ARAGiiNil!t, L.LL J. EPA IO Numbnr <br /> 116,00 NORTH APTFJS Ii N <br /> ARACIONITE' , L1T 8441<:+ p <br /> +4.35•888-171066 <br /> Facillry's Phone: UTD9615.'i2171 <br /> ga. gb.U.S.COT Descnpfion(including Proper Shipping Name.Hazard Class,IU Number. <br /> NM and Parkin?Group of any)} 10.Containers I I.Totts 12,Vnil <br /> No. Type Quantity Wt,Nol, 13WadeCodes -h <br /> x ,;TA.TNING rir; Del 35P. `o <br /> 2FNE), 4. 1, P; I1t3.5., .(GA.�OLZNL, .I, , <br /> o <br /> Lij <br /> Z ~ OLU <br /> c� w <br /> N <br /> 00 <br /> N <br /> U"I <br /> C/1 <br /> C/1 <br /> v <br /> N <br /> O <br /> 14.Special Handling InsVuc@ons and Additional information - 81647445 N <br /> 1' CGaC' <br /> 24H "•!vtf-P. #��: a 175@ Tr_ r, " ritst811TF fD <br /> an to it.iun:. yOr, C� <br /> 15. GENERATOR-SfOFFEROR'S CERTIFICATION:I hereby declare that the collects of this consignment are fully and accurately described above by the proper shipping narne,and are classSh d packaged, rt' <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 1 am the Primary <br /> Exporter,I certify[hat the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent, o <br /> 1 certify that the waste minimization statement identified in 40 CFR 262.27(a)of I am a large quantity generator)or ji(if I am a small quantity gonerall is We. rt <br /> Generatorsfpdemr's Pdrtled+Typed Name Signature Month Day Year v <br /> 1 �c-f, i l7q• <br /> J 16.fntemational Shipments <br /> ❑Import to US_ ❑Export from J S. Pod of entryfexit: rD <br /> ? Transporter signature(for exports only): Date leaving IJ,S., <br /> 17 Transporter AckrloMedgmenlo[ReceiplofMatefials rD <br /> 0- <br /> to <br /> Trarxgporler 1 Pdnted/Typed Name Signa ere Month Day Year �• <br /> � � 1\l:.� �• 1 - � 1, i' ', 1 1 � <br /> Z Transporter 2 Pratte IfTyped Name sign�we Munth Day Year � <br /> Q <br /> 18.Discrepancy <br /> n � � <br /> 189.Discrepancy Indicat an Space ❑ 0ul ❑Lype ❑Residue ❑Partial IFull Rejection <br /> G O n <br /> O <br /> Manifest Reference Number O <br /> 18h.Alternate Facility(or Generator) U.S.EPA ID Number <br /> � O <br /> 3 a 2k <br /> t Facility's Phone. �(] <br /> 3 1Bc-Signature ofAllernate Facility(or Generator) O <br /> r Mnnth Day Year Cl) <br /> C <br /> O ) 19 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 00 <br /> O <br /> 67 ? 1. 2 3 4 v <br /> o <br /> it <br /> covered by the manifest except as bled in Ilam 18a <br />