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. �j J III! llll llll l�llll�allllllll II!l��Illl! !� ' <br />Please omni or lvoe: !Form designed for use nn PlilP 112.niicht hmM. ntarl Form Anoroved OMB No 2050-0039 <br />. 1 <br />4 <br />s.. <br />.1 <br />UNIFORM HAZARDOUS <br />' 1, Generelor ID Number <br />2 Page 1 of <br />3. Emergency Response Phone 4. Manifest Traaking Number <br />I` F L E <br />WASTE MANIFEST <br />) �� �t3�3 E <br />1 <br />19775772-69 008631527 <br />S, Generator's Name and Mailing Address Genotator's SiteAddran (f different than mailing address) <br />nallar General ##14353 !f Doll;�Lr CanerIM435; <br />( "��757377 915 E YOSEMITE AVE 915 E YOSEMITE AVE <br />Gonere(oesPhone: MANTECA, CA P11I `3TECA, rttft 95-336-5928 <br />6. Transpo er 1 Company Name U S. EPA ID Number <br />Stur'it'Ycle 91jac'lalty Waste Solm ions Inc irNS000110gan <br />7,Transperter4camp-pM o U.S. EPA ID Number <br />8,Designated Facility Name and Site Ad rasa Dencral, ErrlironviCniAl MUtrt LLC. U.S. EPAID,Number <br />' <br />11855 Whito Roel( Road -V ` <br />N�f"rvho Cordom, CA- 957'42 <br />FacilllyrsPhone; '�1�351+�9�� CAD9B�88�AB3 <br />ga, <br />9b, U.S. DOT Desopdon (including Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Grogp (if any)) <br />10. Conlamers <br />11 Total <br />12. Unit <br />13. yJasle Codes <br />HM . <br />No, <br />Ty�y-•'• <br />Quanls(y <br />Wi.NoI; <br />1 UN1950, butts Ae?Yosol%s Flalnfaoblo 2.17 ERG#f125 <br />1 <br />CF <br />00007-ia <br />P <br />337 <br />D001 <br />. <br />LU <br />�y/ <br />A <br />11 1l t7t��y f� y,7 <br />2' i/Jt[�{Eiy:�i.y7,j.�7� F$Yr�5t0.1} �'rlyc3iltf''r�iT.bl err 8r s. <br />.1 <br />I <br />r�p� <br />4+ff� <br />r�tf,•t� <br />�'1�5.1f 0.3 <br />�y <br />P <br />+� <br />331 <br />7x <br />�Yif�'�� <br />ru�`�jj1A}1j.,{Rr`i]t�id`4f <br />VIX'f%irl �.1F^+17yr1C..rr <br />^,�Sy�• <br />-y <br />5 <br />�r(Ahl <br />*•t' <br />3. •.�wnsuater Elat-Li aniiW , r o +`et�'1yC1.Yng LL7 fit r.? <br />I �' <br />�%1'� <br />LJ' `U0 <br />'' <br />I` <br />' <br />A.Gi <br />Waste), {'� � ' <br />4. ,plo n RCRA hraz4rdaul wavti l-`ftgh1d toniumer <br />I <br />DF <br />0015 E•- <br />7,3 3-1 <br />pooduc#; S) <br />m <br />r <br />14.9pccJalandlingl`Min"tiof�t�tQ T"0040 information 1, 110541 (Aor "moos) 2. 110518(F lammahle liquids Loosepat*k) ;i. <br />1 ( i�(CpllartAlE'Y` Ela tronicslfer Recyclipgg % 4e_17.0524(Non—RCDP! 3.. g4id Waste tCA Only) <br />SS. 69NFftATOR'SMFFEROR'S CERTIFICATION: I hereby declare that the contents of thlsconsignalkni are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and tabOed/placarded, and are in alt respects fa proper wrldQdan rortranspart so= drra lo applicableln6matmnal and rratkrnalgovernmental rejubbons. If export shwerrtand i em the Pnmary <br />Expoher, I certify ibat the contents of this consignment conform to the farms of Bra atlaehed EPAAcknowledgmem of Censent <br />1 cert'rfyrhat the waste minimization Matement Identified in 40 CFR 262.27(a) (if I am alarge quantity generator) or (b) (if I am a small quantity, generdtm).rs true. _ i <br />I" to y am@ r dna :�` � ay Year <br />„ <br />rmonw <br />Il I i 1 1411, 'kA r'vfhi' <br />J <br />F_ <br />. ntdrrrrKa pments�•-�` <br />ljlm`port to U.S. ❑ Export from U S. !'Port of entryleml. <br />Transoodar signature (for exports on€yl• Date leavinq U S: <br />W <br />17.TransparterAcknowfedgmenlofReaeiptofMaterials <br />Transporter 1 Pnnted/iyped Name Ignatvre ;;;Monitl;;{' ay Year <br />Tnrht3 1 PI pw <br />Trapsporie2 PnnI CUT Name slurs Monro Uay Year <br />( U`rt(�c�-� I t I! I! b I! <br />18 D)screpancy ' <br />1 So. Discrepancy indication Space Quantity ❑ Type ❑ Residue1 e1 <br />❑ Partial Rejection ❑ Full R ecbon <br />Mandest Reference Number. p <br />18b. Aftemale Facabty (or Goneralor) U S. EPA ID Number <br />J <br />V <br />' <br />ILL <br />FaclllttrsPhone• y <br />13 <br />18c, Signature ofAltemate Faulity (or Generalq _Month Day Year <br />I I I <br />19, Hazaritous Waste Report Management Method Codes (i e„ codes for hazardous waste Imatment, disposal, and recycling systprgs) <br />tu <br />0 <br />1 �{, <br />] 2. 1 )r i I3. 4-1 i 1(,1) I4. <br />111) +1)41 <br />-ofhazard`ousmatenalscoveredbythemarxfestexceptasn0 <br />20. Designated`FjvC dy-Ona orOperator,�fco <br />0l <br />Prmle a + Signature Month Da Ye <br />.1 <br />ERF 70E 22 R <br />revious sddi al'e-drssolele. r' <br />DE61GNA <br />__ <br />TY TO GENER¢70t2 STATE (IF REQUIRED) <br />