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FORM #FS-UHWM <br />UNIFORM HAZARDOUS <br />21. Generator's US EPA ID No. Manifest Document No. <br />22. Page <br />ion in the shaded <br />WASTE MANIFEST <br />es 1 1 (� () t j �, <br />not required by Federal <br />E <br />(Continuation Sheet) <br />i <br />23. Generator's Name <br />L. State Manifest Document Number <br />5AM JOAQ6IN Co91FIY <br />Aft, -16172912 <br />MO It @[AZLXT M <br />M. State Generator's ID <br />16-TOCKTON s x 95201 Ait4f`I a RLyao s eoil401i <br />(209) 468-4066 (2i)9) 463 <br />24. Transporter Company Name 25. US EPA ID Number <br />N. State Transporter's ID <br />O. Transporter's Phone <br />26. Transporter Company Name 27. US EPA ID Number <br />P. State Transporter's ID <br />Q. Transporters Phone <br />29. Containers <br />30. <br />31. <br />R. <br />28. US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) <br />Total <br />Unit <br />Waste No. <br />HM <br />No. Type <br />Quantity <br />Wt/Vol <br />a. <br />(L&b-pack) (DOT -9--13192) (pf : 744525s <br />i:) e <br />P <br />5 i (t <br />b. <br />(Lab -pack► rD QT -9-1319;) , ,p.C; M9865) <br />C. <br />No <br />a13021, PQ 11, (Fyret.hrjna, oftl%)rdarer) (p«,, 744622) <br />G <br />d' <br />E <br />{IsfazlaaN: n1eu1[yheat . f{>C ra�s,':aj <br />N <br />E <br />r <br />R <br />.. <br />A <br />e' <br />(tAb-pwik) . ({+t: 34464,4) <br />T <br />0 <br />r3 kr <br />F <br />wla <br />R <br />f- <br />6564.031 . <br />e.�• <br />r? <br />adr�... <br />g <br />TI, (t4b-pack). tpf, 648402) <br />G IF <br />7 <br />P <br />:1st <br />h. <br />462315, PQ llt, <br />:MO` M DAT$; ," (pf ' 704$39} <br />i. <br />(ef! 744628) <br />S. Additional Descriptions for Materials Listed Above <br />T. Handling Codes for Wastes Listed Above <br />* 2OA4 744S2 301311 795683 ( } r,+ 215Cz 74+1522 ( <br />7443217{ 74460-i{ } *� <br />201'; 6989024 i *a 290: 6984021 } ** 2817: 7445341 a r <br />+* 267; 744$28( ) <br />32. Special Handling Instructions and Additional Information <br />Waste is RCRA exeept ger 40 f-'fR 261.4(7$) (1) exclusion. wear proga r PT'S W.1es handl.isg hex*VC1 iAs <br />wAtotials, 9itel520 6, Tracy Blvd, Tracy CA 9053761 Job 8 1403-1717200 1 tike Suide 154 1.32 151. 3.41 <br />, 140 , 171 . 126 <br />T <br />33. Transporter Acknowledgement of Receipt of Materials <br />Date <br />A <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />N <br />s <br />P <br />R <br />34. Transporter Acknowledgement of Receipt of Materials <br />Date <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />A <br />35. Discrepancy Indication Space <br />c <br />L <br />I <br />T <br />Y <br />