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Fmmluuvnvnd 11rARNo.2050.0!)39 <br />Pieaae <br />;)Illi; 0r lyp54 (i'arnr tla9tJill ed far Oaa 011 BIIIB 12•P31rJt) lypa'!m af. <br />2.Pag�1orE3EmerljoncyResponsePhare 4.ldonlfos-- stTraekn�jlumeer�Q <br />UNIFORM HAZARDOUS 1GenernmrIDilc,r,er <br />®`� 89 FL <br />WASTE MANIFEST CAL000415976 7-7 5 " `° <br />G. Canore!grs Nmnn olid lla4lx Address Ga ae4ur's S'.te /ul reSa (IId Ilerelll dlall @ItK YJ n d!esa) <br />0 ulter oDuld Mr;: eal reudatiol,1Sttackt9f1 Muuieal Plaza Sutter ODuld Motfm'al FGudatiolb atotktun M1dGsal PIM <br />255 W t-lanlfnur Iia 2505 W Hammfar 1_11 <br />Stoddon, CA MOO Stockton, CA 951209 <br />553-;3t)'�-�1093 <br />Gcnara.orsPhons: U.G r:PAIDNumLc <br />i ransppttcr UMI) :1 lama CtLO=70179 <br />HealihtASe St GD3 <br />7 ltanspu+ter 2 Cai'pany rJanw USE"(P��AI�b rlun>'>a+ �y q <br />�J �-1 <br />r(?✓•-� ®f � �� �/V I G ,.�c7t..�Q 1 ■(J/�-�` <br />U.S.EPAIDiI�bc���rs� <br />0,)rp st d Fn K, an I S11 less <br />tT9 PICCJC 1Ca7 Wt'Vi DA <br />14114' 954 11 Mllus South a? DwIty NV733(1010000 <br />Buaity, hJV BOOM <br />775-5,53.2203 <br />Frnjilij <br />s Phan : <br />9b. U.S. DOT Description pnchlding proper sNpping Name, Hazard Class, l0 Number, <br />10. Containers <br />it. Total <br />12. Uryl <br />WtNol, <br />13.4Yaslo Codes <br />9a, <br />HN <br />and PacWtig Orcup (it any)) <br />No. <br />Type <br />Quantity <br />o <br />2 UN2821, WaSto Phenol solutions, 6.1 , It <br />DFP <br />331 <br />---- <br />X <br />3•NantRGRA Fl ardeus Waste, UgUld (Gurf`dcataIIIIS) <br />t3"r <br />P <br />f�f <br />4 Nolt�RCRA t-tazai WaSte. Uould ( tturan) <br />311 <br />I <br />DF <br />P <br />14, Special Handling Inshudlons and Additional twormallon t; DM73 <br />t; X <br />j3 , r 3) 07013157D-31028 <br />2) 070131570-82338 ERM53 7th 4) 070131571XI'121V 1 �(6 <br />15, GENERA70R'SfOFFEROR'S CERTIFICATION: I herebydedarelhol the contents of us consignment are filly a'+d occUmte•y descntcd above by the proper shipping namo, and am c'asslrad, paclaged, <br />na9onai reguteticns. If export shipment and I am the Primary <br />marked and labeledlplscarded, and aro in all respects In proper condition for transpodacoonrir!g to applicable Inteme6onal and plemmenial <br />Exporter) I certify that the contents of this corslgnment conhum to the (arms of the attached EPAAcimovdedgmentof Consonl. <br />I certify that the waste mWmizatan 6tatomenl identified in 40 CFR 262.27(a) (III am a largo quantity generslor) or (b) (It 1 em a sm0!111 I'mmty genamlor) Is huet <br />t�) ay rr�r <br />le <br />t3onemfrNyt)'ern''� ra t yTaxjr�ianra a <br />J' AX -:' <br />16.Irdsmetmoi'n;prtsnlu I^lt to U.S. ❑ExportframUS. Poll ofentryloAl!__• _------------ <br />Tfans All!" 1 alum for erp•Ati on' Dale!esv'nq U S,: <br />17 TranspoiterAcknabiedgmenlofReceiptofMateriels �° <br />O <br />ter I P14�*cJ' �yxi N .i,4,ma urs 47 <br />tt. <br />:AJnnh,t0 sol lay ar <br />r'l1'rinU!rt' knn><a <br />Z2V <br />t0. Dsnepaccy 1t--�� rr---Tr <br />10a1J. Discrepancy Indication Space Quantity Typo LJ Residue ❑ Partial Rejection Full flejodron <br />�rurJ'esl Relernrca f lumlxr. <br />IDllund <br />US.EPdrr <br />F— <br />luc 'Fedty(o0Cejvr)!sw) <br />l+.Atlrna.G'i <br />v <br />' �� — <br />'Telt( <br />uQ. <br />Faci�iv` P -- <br />f•1',Nltll^ Day <br />W <br />Inc iYlnafumnlNlamub!I' udy(arUunnmtar) <br />iri <br />���� <br />Z <br />19. Hazaatous Wasto Report hlanagement Molhod Codes p.o., codes for hazardous waste t'eahnenl, disposal, and recy(rtaa systems) <br />20, Desionatcd Facility Ozmeror Operofor. Cortication of lecoipt of hof haazardous moledols covered by the manifest except as mled in twilka— <br />f,'rmih D1ay Y4ar <br />Pdnteiif <br />Folin 0700.22 (Rev. a-05) Prev oil u(11110i are absovr n, DESIG14ATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />EPA <br />