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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 />Information in the shaded <br />WASTE MANIFEST <br />C A H 1 1 1 0 0 0 8 5 7 1 1 2 0 6 <br />2 2 <br />areas is not required by Federal <br />(Continuation Sheet) <br />of <br />law. <br />23. Generator's Name <br />L. State Manifest Document Number <br />ME JOAQUIN COUNTY <br />24411206 <br />1910 N HAlIMON <br />UTOCRTON, CA 95201 ATTN: RL1909 HUDSON <br />M. State Generator's ID <br />(209)468-3066 (209)468-3066 <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. Transporter's Phone <br />28. US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) <br />29. Containers <br />30. <br />Total <br />31. <br />Unit <br />R. <br />Waste No. <br />HM <br />No. Type <br />Quantity <br />Wt/Vol <br />a. <br />, <br />UN3029, fA III, (Alkaline Batteries), (pf: 620749) <br />�3 <br />t/ 1 <br />D P <br />r <br />p <br />612 <br />■/R <br />b. <br />(pE1 744724) <br />D T <br />612 <br />c. <br />p t: 744536) <br />612 <br />G <br />d, <br />(pr: jD <br />J <br />(r <br />�G�X� <br />612, <br />E <br />P <br />1/R <br />A <br />T <br />e <br />f <br />�fQ ✓V! Y�fcc i� i /&\j <br />;r�it <br />) <br />R <br />f. <br />9- <br />h. <br />i. <br />S. Additional Descriptions toMaterials Listed Above <br />* 28A: 620749 ( i x �O ) +►* 291: 744724 ( / jr5' ) t* 29C: 744536 <br />T. Handling Codes for Wastes Listed Above <br />** 29D: 744327(4 }o�r * ZSF (7116?q, Z x5S) <br />32. Specie Handling Instructions and Additional Information <br />waste is aCRA exert per 40 crR 241.4(b)(1) exclusion. tear proper fff when handling hazardous <br />soterials. Bite:3249 X. Tracy Blvd, Tracy CR 93376/ Job 5 1493-06200 / ZING guide 134 138 171 , 127'�Z <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 />0 <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 />I <br />L <br />I <br />T <br />Y <br />