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raved.OMB Na.2050-0039 <br /> Form App <br /> Please print or type. `—'1 r" �� F <br /> 2.Page o mergency Response hone 4.Manifest Tracking Number FLE <br /> UNIFORM HAZARDOUS 1 Generator ID Number - 015 9 4 0 6 <br /> WASTE MANIFEST eE3 0Z <br /> Generators Site Address(if different than mailing address} <br /> 5.Generator's Name and Mailing Address <br /> pep �QyS #710 Jr. <br /> ;«tt�v5#71:Z <br /> (209) 464-6066 845 Dr.M.L,King blvd 845 br . I�. L. King Jr- Byrd <br /> Generators Phone: Et QCkt GTl � 's u.s.EF'AI I Numher <br /> $.Transporter t Company Name <br /> U,S,EPA ID Number <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> 8,Designated Facility Name and Site Address General Environmental Mgt, LLC <br /> 11855 White Finck Road <br /> Rancho Cordova, CA 95742 <br /> Facility's Phone'. <br /> 1f1.Containers 11.Total 12,Unit 13,Waste Codes <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, e Quantity Wt.Nol. <br /> HM <br /> and Packing Group(if any)) N°' Type <br /> oc X 1 UN1950, Waste AeroSOlS■ [flammable, (each not i CE P 41� � �1 <br /> ��t X10 <br /> o €, <br /> exceeding i L capacity) J 1, EPG#1�E <br /> Z p <br /> W <br /> C) <br /> 3. <br /> i <br /> 4. ,. <br /> E <br /> i <br /> 14.Speoial Handling Instructions and Additional Information 1.78.275(Aerosols, Flammable) <br /> fied <br /> 15, GENERATOR'SIOFFEROR`S CERTIFICATION: I hereby declare that the contents of this consignment are fully. <br /> and ccuronala nd ely de scribed <br /> go ernmentah regulate proper <br /> shipping nameshipment a cla asi the Primaryd <br /> marked and ladeledlplacarded,and are in all respects m proper condition for transport accordingto app <br /> licable Exporter,I certify that the contents of this consignment corform to the terms of the attached EPA Acknowledgment of Consent, small q ntily generator}is true, <br /> I certify that the waste minimization statement identified in 40 CFR 282.27(a)(if I am a large quantity generator)or(b)(' Month Day Year <br /> are t�ta( ero PrintedlTyped NBre <br /> e <br /> _j fi.International Shipments Llport Imto U.S. ❑Export from U, Port , <br /> Dale leaving <br /> leavvinging U.S.: <br /> ? Transporter signature(for exports only): <br /> W 17.Transporter Acknowledgment of Receipt of Materials Signature Month Day Year <br /> Transporter 1 PrintedlTyped Name "ac:, <br /> p Month Day Year <br /> I Sign ur <br /> Z Transporter Fin ted[Typed Name <br /> f- <br /> 18.Discrepancy ❑Fult Rejection <br /> ❑ ❑ <br /> 18a.Discrepancy Indication Space ❑ Quantity Type Residue ❑Partial Rejection <br /> Manifest Referenre Number: <br /> U.S.EPA ID Number <br /> 18b Alternate Facility(or Generator) <br /> V <br /> Lai Facility's Phone: Month Day Year <br /> Liu 18c.Signature of Alternate Facility(°r Generator) <br /> a <br /> Z <br /> S2 19.Hazardous Waste Report Management Method Codes(i.e„codes for hazardous waste treatmensal,and recycling systems <br /> t,disposal, 4 <br /> LLI 1 2. <br /> O ' <br /> ont y Year <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the ma este ept as nded in tem a <br /> p Inte yped Nama <br /> rrpr DESIGNATED FACILITY TO EPA's e•MANIFEST SYSTEM <br /> EPA Form 8740-22(Rev.12-17) Previous editions are obsolete. <br /> ---- -., a,�„-2 r•ts'Pt7€VIA0057 61199 <br /> 042042456 M PD04072t 31104070:1 <br />