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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number wAS'rE MANIFEST C 4 D D 8; r' I; 3 0 2 0 7 1 1888-877-72K 1 021324606 JJ K 5.Generator's Name and Mailing Address Att: Manifest ReceivingGenerator's Site Address(if different than mailing address) Union Pacific Railroad c/o GHD Union Pacific Railroad 6621 Corporate Dr. 833 E 8th Street Indianapolis IN 46278 Stockton CA 95206 Generator's Phone: p 6.Transporter 1 Company Name U.S.EPA ID Number :yrr}enran Integrated Services, Inc. C A F 13 0 t7 1 4 8 3 3 8 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Crosby&Overton,Inc. 1830 W. 17th Street Long Beach CA 90613 Facility's Phone: - — A n 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.lvol. 13.Waste Codes 0 11r1A3077,Hazardous�naste,solid,n.c.s.(2A DINITROTOLUENE),9, �° D030 981 X Pt_III n 8 1 Di�71 ✓C,u P Z 2. LU 3. 4. 14.Special Handling Instructions and Additional Information Fslwayz Wear Appropriate PPE -;,rhen handling w25te_ Weights or 4olurne are Approximate- 93_,_1) Profile Number:114880 AIS Job Number:79023-143 WR#23646 _-.lxJ) 15. GENERATOR'S/OFFEROR'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 Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(bJf I am a small quantity generator)is true. Generator's/Offeroes Printed[Typed Name Signature Month Day Year 16.International Shipments ❑Import to U.S. El Export from U.S. Port of e ry exit: ? Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year Tr rter 2 PrintedlTyped ame Signature Month Day Year 18.Discrepancy 18a,Discrepancy Indication Space ❑ ❑Partial Re ❑Full ❑ Quantity El Type Residue Rejection Rejection Manifest Reference Number: 18b,Alternate Facility(or Generator) U.S.EPA ID Number J_ V gar- Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. r 4. 20.be4ginated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signatur Month Day Year Kl� L21 I I EPA Form 871PL ev.12-17) Previous editions are obsolete. 22 DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM