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SSL Ip# 21902032? 1111111111111111111111111111111111 IN III <br /> Please print w pe.(Form designed forum on elite(12-pitch D F 5�3 2 Approv9 4 7 7 5 5 <br /> ed.OM2B No.2050-0039 <br /> UNIFORM HAmDOUS 1.Generator ID Number CAD982485351 P 1 d J 4. I haokin umhr <br /> RD9824A5351 age) ^+ ' 't � 0 0 5 3 F 9 4 71 SKS <br /> WASTE MANIFEST <br /> 5.G1naj Ws Name aM Mpifrg Addmss Generetds SlteAddr (ddiRerenithen maing address) <br /> dl—Trans `ihnp 1.0- i.^di Gws <br /> 845 E Pine St <br /> !J10T CR 95240--17.109 <br /> Generators Phone: <br /> 6.T".r"Y" SYSTEMS, INC. U.S.EPA ID Number T%1?0000A1�:'tTrS <br /> 7.Transporter 2 Company Name US.EPA ID Number <br /> 9.Designated Facility Name and Site Address f-1-FPN HARBORS BUTTONWILLOW, LL.0 U.S.EPA ID Number <br /> i <br /> 1-00 LOKFRN ROAD <br /> 'TTONWILLOW CG 9320E <br /> 651-75;P-'?0!h � CRD9806752' <br /> Fad, sPhone: <br /> ga 9b.U.S.DOT Description(Including Proper Shipping Name,Hated Class,ID Number, 10.Containers 11.Told 12.Uri) 13.Wavle Codes <br /> HM and Cxoup(If arl')) No FType Duanbly Wtild. <br /> t NON RCRP HA'PRDOUS WASTE ^.91TD9. DM P 352 <br /> (AASCIRBF.NT AND 011f' <br /> W <br /> 2. <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TOM'.171 701 PI F70 rPy70-;z'. <br /> 24 HR EMERGENCY #1 WP + .r-1750 'S!'. / TF1; {�� 2° ?� ry10w <br /> ALITH AS "AGENT FOR" A" Ft: TO RETAIN LICFN9En P)19 C !F?1 `:'ECESSARY <br /> 15. GENERATOR'S10FFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are telly and accurately descobed atwve by the proper shipping name,and are classified,packaged, <br /> marked and IabeleNplacarded,and are mall respects in proper condsion for transport according to applicable intemabouland national governmental regulations.If export shipment and I am the primary <br /> Exporter,I ceNfy that the contents of this consignment conform to the terms of the attached EPAAcknowledgmenl of Consent <br /> I oadly that the wash minimization statement identried in 40 CFR 262.27(a)(ti I am a large quantity generator)a(b)(dl am a small quarefty generator)is true. <br /> Gene fypRerora Prints yped Name era Math Dry Year <br /> y1 J\ h b <br /> 18, emalbnal5'pmenls <br /> � ❑Import toU.S. ❑Export frern U.S. Pod dem" <br /> = TraIporter signature gar exports ody): Date paving <br /> 17.TransporterArkraMedgment ofof Materials <br /> Trans 1 led(Typed Name Signal Month <br /> y ct U{' 26 I <br /> G Transporter 2 Pdnte ntedffyped are Manta Day Year <br /> t1e.DisUapancy <br /> 18a.Discrepancy Indication Space El Quantity ❑Type WuResidue ❑PIN Rejection , Q Ful Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(a Generator) U.S.EPA IDH r <br /> J <br /> U <br /> LL FaciNy�s Phone: <br /> 18c.Signatureo emote Facility for Generator) in Day Year <br /> a <br /> z <br /> N19.Hazard Waste Report Manugem art Method Codes(I.e„codes for harardws waste treatment,disposal,and recycling systems) <br /> 1 1— .-a 2. 3. 4. <br /> 20.Designated Facility or Operator:Certifiratpn of t of hazardous materials covered by Ne madfed exceplas noted In Item 1B <br /> 1n ypetl Nmne SignaWra Motion Day Y <br /> P�fa)ny y�, 5�� llSecis3Mobsolete. DESIGNATED FACILITY TO DESTINATION STAT (IF REQUIRED) <br />