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h } (fetF]] <br /> ',.. � t ; ��.y��e ax�� �,y�,r�t,a�+?,Y"''kr. �I�� �t����'����I �.����� -,: � _-___.' +,4 u k�K.� � •^4 <br /> r ¢kF 002151894PSC wr( $. gJ01. <br /> } IYP c? Form Approved,QMB.No."2-0`a0-009:... <br /> UN)F(JRM FAZAR00uS i SenPrator tD Number 2 Page 7 nF .3.:Emergency'ReSpanse pl>ef>e_ Nt St Tracking Number <br /> v� sit MAN cA o sz9 tarn sxr=zss� 0(721894 M <br /> utlr:tht(-t l{�l_ 1rCSY : <br /> Generators Site Aifckess(#d#ferent than mailing addre <br /> s: s)' <br /> RO&S STOFIE#i�tf3S,.. :,' ROSS STORS#wu <br /> 575WPACIFl AVE 5756 PACMC:AVE <br /> STl>CKTON, (2Q91"74202 STOCKTON,CA.95207 2099576202 <br /> {;r.,pr�tlol sF�fone. <br /> 6,1r nsixi ler.1 Ctmlpan_yName <br /> - <O.S.EPAID.Number ' <br /> s�RICYQ a sPi cwa�Tvwias SOLUTIONSINc �tivsovo11004 <br /> T.lranspnRNr2EontpaftyF(aine U.S AtDNtalrkteF <br /> JjA <br /> 8.Qi yi4Atafc d EaciktyNam2 and Site Add(es5 :. . .."U.S.EPA IQ Nulid>et <br /> 21st Century►F.�tv{rcffamentat Main9ement of Nevada I.LC <br /> .2095 Newland :Cr nasi, t41/d96069 <br /> 5338 .. <br /> Frrfltey'NV S94t�6 :{716).575-2760 <br /> F.a ArI's Ph <br /> onf <br /> g� 9b.VS p0T Description(krcludxng Proper Shipping lone,Hazard Class:!p Number, V.Contaaier : if.Val 12 ting <br /> NM: Aid Packing Croup(#any)) Na: Type Quantity131Afacle CtrCes <br /> i UN28t0.WASTE 71IltIC,UOUIDS;ORGANIC,N.O.S.(LEAD,SILVER)Gw1 PGB <br /> 331 DOW 0006. <br /> O .:X y OF P <br /> 2. <br /> DOtt Doth <br /> w <br /> C' <br /> 3. <br /> -4 <br /> 14.Spe al Handling lnstru s and AdditionalInformation <br /> . (1)ROS$ftt-D6-ERG(153)ROSS6.1.06-TOl(IC LOO&EPJICK' r ' _ <br /> 15. GENERATOR'S(QFFEROR'S CERTIFICATION:t hr.bydeclare that the contents of this consgwatare fully'and accurately dMaft d alim by proper shlppping,name,and are classified,packaged, ; <br /> mlirked al td laheledlplacarde i and are in all respect;in!roper rondilionfor transport Kwdatg to applicable yi(ernationaland national governmenteil regillalans;If export shlpment.ancl1 am Ute Primary. <br /> Exlinrtm;I r. tlty that gte contents ofthus copsignment confof m to the terms of the attached EPA kknawkdgme df Consent: , <br /> 11.114 fiy that the waste m nmtiiatkm&tateaietit iderdified iii d0 CFR k-..27(a)(IFI arta larye ouuTitity generator)or(b)(F f am-a small quantdy.gerler*o <br /> (.ienPf t)S�QFfPfnCS Prmterinyftetl ,ame - - MM1At Day.. YKW <br /> 3. 6 . ;: 19 <br /> LAX <br /> d.> . <br /> 18 Intonational upment�. <br /> 'Elimport to U S, Export 10o U.S. Pod of entiyTex4:: . <br /> Z► r <br /> ranSlHtrlrr s gn ttfue(larexpar(s only): CIale leayirig U.S.: <br /> cc lI TYa17SporterAcknoWlet(lntentofReceipt ofMaterials, <br /> .LLI <br /> Tr,•trr;onav,i F fedi ypea name, SignaMe Month Day Year <br /> Q <br /> Chris Gilliam . <br /> 3 6 19!` <br /> z.Train pdrter 9 thinted,'Typed Nante Signature Qay year <br /> Q 1 <br /> !P��' <br /> CC _ <br /> 18.!?nrnllktncy , <br /> t&t Drsfrcytrijry3nrlicatianSpare a Ockmldy QTypej. ORosdue Opartial Rejectwn QFultReijection <br /> Manifest Refer ice Number: <br /> 18b Ailemate Fatality(or.C'enerator) t1.S:EPA 10 Ntenber <br /> . .W fac.ilily7PhortE):. - . . . <br /> !&.Signature M A@ernale Facil ly(ar Generali rl - Month Day year <br /> LuQ <br /> 15 H vnnlous Waste Report Manal;meat Method Codes(i.e.,tildes for hazardous Wasle'treaWkint;disposal,and recycling systems) <br /> i. 2, 3 9• <br /> H141. <br /> ifyiated Ficility Owner or Operator.Certi7rcation otrereint of hazardoiz materials coveted by the manifest except as noted xn+tem Illy ` <br /> 1?rxi',rdi`f vur Name Signal a Month Day, Year <br /> I PA Form 700-22(R,,:12-17)previous e(k iotas are obsolete DESIGNATED FACILITY Ta'EPA's e.-MANIFEST SYSTE <br />