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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 86Em6erg��y Resp nse Phone 4.Manifest Tracking Number WASTE MANIFEST CAD 9 8 2 0 3 0 2 0 7 1 � j 018853833 JJ K 5. a ator's Namnd aiUOq Address R EF n ator' ite dreSg(i iffere t than mailing address) 1400 YeDouG las Street-Stop 1030 933 E 9th Street O=ha NE 68179 Stxftn CA 913206 Generator's Phone: 9 1 6 6 4 0 ` 0 4 9 6 6.Transporter 1 Cornny Name U.S.EPA ID Number American ntegrated Services.Inc. CAR 0 0 0 1 4 8 3 3 8 7.Transporter 2 Company Name U.S.EPA ID Number 1AC- �Nd 0 ro dc°v 1 C u) 9 8.Denot d rF ciI' Na and ite Address U.S.EPA ID Number iytireron,i . 1630 W.17th Street Long Beach CA 90813 Facility's Phone: 667 4M-6445C A D Q 2 8 4 0 9 Q 1 9 9a, 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1-NowRCRA Hwardous VYtnte,LWW(Anfteeze) �� 331 0 Z 2. ,800d-M NOW ulI -- 3-Nen N11 WME 4TIOTF17M. r i 14. g1!l an ,E8,64Vn d lIfgmahogndling. Weights or volumes are approximate. 9a.1. 112418 9a.2. 112417 9a.3. 112419 9a.4. 112420 / RR#21894 / AIS ob#79023-44 I-) -�1- 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgmonsent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator or(b))if I am a small uantity genera true. Gengffs%rgjs Print ypec�ame �t�r J. � Si nature Month Day Year � 16.International Shipments OT(7@ u^■tf f— ❑Import to U.S. El Expo om U.S. Port of entry/exit: — z Transporter signature(for exports only): Date leaving U.S.: W17.TransporterAcknowledgment of Receipt of Materials Transporter 1 PrintedfTyped Name Signature Month Day Year 0- QtLZ&TZV QTra iter 2 Printed/Typed Name 4 Signature Month Day Year k CA- (A LVIL C 16 R. 18.Discrepancy ��II 18a.Discrepancy Indication Space F-1Quantity ❑Type u ResidueEl j Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J v Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. � 2. 13. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name Signature Month Day Year �j ZI EPA Form 870 ev.3-05) Previous editions are obsolete. DESIGNA D FACILITY TO DESTINATION STATE(IF REQUIRED)