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Please Print or type.(Form designed for use on elite J12-pitdl)typewri(er.) Fon Approved.OMl3 No,2050-0039 <br /> UNIFORM HAZARDOUS t•Gt nenamr Ip N tr 6er 2.Rage t o3 Y Emergency Response Phone 4.Manifest Tracking Number <br /> WAS1ElrIAHiFEST CAl_�Oss14z5 t 800-03.3253 1 015326026 JJK <br /> 5.Genmlo?s Name and NalrngAddress AT N.Carla plw, Ger eratar s Site Address{f d�erent than mating address; <br /> 1{a7 Commercial <br /> rcialPaw C:orrr�sany KeRy&bore Point Company <br /> aa7 Carlos, A j)70 2625 N TfacyBM <br /> San Carlos, 0' P4070 Tracy,CA 95076 <br /> Generators Pticne: 2t]sS-83-3--7d94 <br /> 6.Tra older 1 Cor pany Name U.S.EPA ID Number <br /> Inafia tt)) 4{4;tp11e8�IFFRi P1 aNIE-Cuss ID9 8765-cia021 C.V1'nl�(�17�7d7 <br /> 7.Transgv ter 2 Company Name V.S.EPA 10 Nu rOw <br /> billard En4fonmentell 5t:tnices 3433 <br /> t�8252 <br /> 6.Designated FadirlNane and C AD <br /> Sita Address U.S.EPA 137 N 252 <br /> Rieieca <br /> 1007 WCan Rd.PO eox729 ARDS141057870 <br /> Beritatj,AR 72015 <br /> FadSt rsPficmi 800.377-4692 <br /> ga, gb.U.S.DOT Des*um(IndLdr g Proper Shipping Ma ms,Hazard Class,IU Number, 10,Conatners <br /> HM and PROd g Gwup{ifany)I t1.Fetal 12, nil 3.tiYasta Codes <br /> Mo, Type 4usafity WWof. <br /> bN195D,Waste Ar_rosols,flammable,2.1 D <br /> bN12153,Waste Paint,1,1i,RD,D001 <br /> `� 7( VM 331 U601 <br /> X UN1263,Waslts Paint,3,0,R0,D001 531 D09i <br /> P4, , <br /> f 4.Spepal fiandCug Insirud xns andRddit enol lnfcnnat on <br /> Dotumeia 1 29515 SRtes Crdar 400613 <br /> 1')PmfiI0d'1 609-1 988 0 DOTERG9126 1 y 155,A-2 {3J' GP, s)PnoGfe,jr,"-i954� F:Ro#'sr:3 I Y 55 <br /> 2)PMfile f1f=0&-19.342 D0TCRrBFi28 - Q ` D? A--I Drip <br /> 15, GENERAYOR'SIOFFFROWS CERTIFICATION: i hereby decum oat Ine conlenis of the crosS mem ere fuay and accv ialely described abwa by the proper$Nppalg rsyne.an!are a�.-iJsi 0.0* d, <br /> marked and Wwled;placarded,and are, of respeas in vopormrdrtion for transport 4=fdh:g to appiksble intemabonaland nat u-nal gcremmtr.V regulaions.If expo;shlpmert and I em lire Prkm y <br /> Exporter.I mortify that the conlenls of Ih' mnsigrvnent eonforrn to the temp of the etradted EPA Adivmedgmeni of camerrl. <br /> I oersi tial the wasw rnirdm zatlon rMlamantidenfed Ln 40 CFR 262.27(a)r I am a Lvp gmn§ty generate)or(b}{f1 8 sma11 qva generafor][Aa <br /> Genera sORarors PsnledlTyped N SBnahrre $�l4 Day Year <br /> J 1fi.lnt"tiiwn i Stiprncllt$ <br /> i ❑Import to U.S. ❑Expat fam U.S. f onto[a kweAt <br /> — 7ransperter S gnalk;m(for exports on'y): bale leaving U.S. <br /> w 17.TranspmlarArkwQecpgm nt of RAwIpf of rtaleials <br /> "7r�t2;ftnteldff <br /> S a W 'car <br /> R. <br /> 4 auru wowNolth pay Year <br /> #8,Disrrapa ncy � <br /> 1$3.(isaepexy Irdicaum Spaoe ❑ GWanU <br /> lY ❑Type ❑Hesddue ❑Panzer Reiedion ❑Fu6 Ref ecdon <br /> Test Refeww Minter <br /> 15b.Allerrra� OW (a Generales} I <br /> U.3-EPA 11}Number <br /> J <br /> U <br /> LL Fat;iL y'e Phone: . <br /> uuj IBC,Signature ofAltemaleFa614(or Gcneratorl IlonO Cay r Yea' <br /> a <br /> x <br /> 19.Haza.dous Waste Reparl;+tanagement Method Codes(i.e.,wdes for hainrdous waste vea',mam,6sposal,sr,d recorg syslasrs) <br /> I <br /> k�l \ 2 - 5. <br /> e. <br /> 20.Designated FacEty Owner Dr Operator Qj[fficadon Df recepl of hazardousrrWarias Meted try dr@ ntatiiast a oe^t as edad in I:-m 1 k <br /> P . adlf Name Ss� t' fac to Day ++Yea: <br /> ff'A Fvrrn 87U0-2 tRay.3 0 ] Previous edlGans are Qbsolele. DESIGNATED FACILI-FYTO �� 1 <br /> L <br /> DESTINATION STAT~(IF REQUIRED) <br /> A r 4 147-nA d74a-C <br />