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Please ' t or Fofrri.flaz i nee lar use on slits(12-pitch)tymm"Or.) SC 'l�/14 7 Foran Approved.:0Arl8IVo.2(#5(1-0039 . <br /> UNIFORM QkiS I..Gene <br /> Ql Numberpie 1.of 3.Emergency Response Phone Nle g mbar C e <br /> WASTE MAMFEST ` 1��G <br /> 5. arsior s.t ms and dress Generaia's ('Mikese•(i entthan mailing address} <br /> Owsowkwuc <br /> 61iY. 2526 W 1KuNnOur.&X-M. <br /> awdmifLCA <br /> ' StocktowCA 2+� <br /> ` 03 <br /> Gem s Frtrar :: <br /> Y U.S.MID.Number .. <br /> 7.Transporr ray U.S.EPA ID Number <br /> Fa—dty Name mixt S49 Ad U.S.EPA IDNumberr <br /> &MMMdkFKUC. C.A D 9 8 a'6.T5°2 7 6'` <br /> ROW <br /> D6Tdlasaiptidn Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> :tiM and Par*Ing Group(If any)} No. Type Quantity Wtivoi. <br /> 9 <br /> 3: <br /> 4. <br /> 14. g kmhW=.and Adiftnal.InkffAft <br /> f5. GEMEfihTi)it 1 it'$ <br /> ttdws that.the contents.of this consigtmrent are fully and accura"described above by the proper shipping name,and are�d, �* <br /> 7l <br /> marked and tabeledOaamted,ondare m prier eonditimfor transport according to applicable international and national govemmental regufations.ff MporEsidpment and i am ft Primary <br /> EXporter,I e y that9he of ttiie a <br /> t4he terms of the atWd*d EPAAcknowledgmen{of Consent. <br /> I Dandy that the waste rninimWOM .. .,: in 40:GFR°2 Z27(a)(if I am a wge quantify generator)or(b)(if 1 am a smail quantity generator)is true. <br /> rintedITY.Pad NEW, Svnature MEM8 ` <br /> SA rt <br /> 18:kt�ma6wr InrpOft,t0 tt S ❑r:vortfroin U.S: end xit• <br /> Tran s' on <br /> Date leaven U.S.: <br /> Month 'fear <br /> 17.TransporterAedgment elf terieipt of <br /> �* Transporter 1 Pnrrte �t1 <br /> gnah <br /> Trsrisporter 2 yWd <br /> to e <br /> 18.MscnapenGy ' <br /> t8a.DisCreanC lndicaW Space .. El hw* Type Q Residue ❑Partial Rejection ROction <br /> Mantfest Reference Number: <br /> 18b.Alternate EaaNty-(t drat :' U.S.EPA iD Number <br /> Favi sPhow Month Day Ye<r <br /> I&SignatureofAn-A ae ty(aGen,. <br /> 19,HaaardwWasta MffwgerqeF4 Nieflmd Codes#r.e.,codedfor hazasnlous walls haebnaK disposal,and reoyding systems) <br /> 4. <br /> Hfit <br /> Fadiffy nar or C7per :.0 in of recpt o hazards matenalscovered by the manifest exempt as noted in It <br /> Signature Day Year <br /> EPA <br /> (Riv t vices s.ait obsolete. ATED FACILITY TO DESTINATIEIN STA�II E(IF.REQUIRED) <br /> far MdtitMOOPOMMOO the f"M is sw"W4 <br />