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bibL <br />Please print or type <br />131131011 <br />bH P* iis41.14464b4.4iwpae, 111110110 11181111111111,11)1111!111 <br />B No „00 <br /> I 4 GENERATOR - I UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />. ' 7'eneratu ID <br />Number <br /> L.HUb 1 bb.g,S4111 2 Par 1' i..5M24tir-/ V 4. Manifest Tracking Number <br />008561937 SKS <br />5 Generator's Name aria Mailing Address Generators Site Address (if different than mailing address) <br />Modesto irrigation District Modesto irrigation ulsrrict <br />PU box 4000 8e8 Woodland Hve <br />MUDEbIU LH 8b4bd -00100 <br />.:sei I MUD80IU LH Jb4b1-1b.i Generators Phone: <br />6gfin142AtearbYbILNb N US EPA ID Number IX800001:118Wd <br />I <br />7 Transporter? Company Name U S EPA ID Number <br />Li. tHht li44t4b1JHb el4S/ b VL 1 NL ii I pifluirLi,iseec:04, <br />8 Des,griaed Facility Name and Srte Address LLEHNHAMbUHb UF bUllUNWILLOW US EPA ID Number <br />8730U LUKLAN HUHU <br />bUllUNW1LLUW , LM 'd48012 <br />881-18d-880u LHifid08/Zrdit <br />Facility's Phone I <br />ga gb U S DOT Description (including Proper Shpping Name, Hazard Class, ID Number, : Containers 11 Total 12. Unit yo,A and Packing Group (if any)) r, Type Quantity Wt.Not 13. Waste Codes <br />tNUN-MLNH MALHKUUU5 WOblt, 5UL1Ub, <br />(U80115, PLINULLUM HYDHULHWBUNb) <br />DM P ees <br />2 4410 <br />2,4111.10- NUN -KLHH MHLHHDUU8 WH818, <br />LlUUili8, (LILLY WHILH), $0.080- 2 <br />UM <br />53(0 <br />P 181 <br />___ <br />*ti4M10.4UN KLKH HHLHKUUU8 WHbie. 8ULiU8, <br />iPLIKULLUM UlL NNU U1N11, 44044011us, 2_. 701 <br />ees <br />14 Special Handling Instructions and Additional Information 181):bL MUJr1i0 Lbbil <br />g- 1 1 4.36(it) Vi 55 <br />d41-1 8M8H8LNLY41d16w -488 -1/00 -LH/811%/th! -Lontract retained by generator canters agency autnorit) <br />on initial transporter to add or substitute additional transporters on generator's behalf.. <br />15 GENERATOR'SrOFFEROR'S CERT1FSCAT1ON: I hereby declare that the contents al this consignment are fulty and accurately described above by the proper shipping name. aid are ctassfied. packaged, <br />matted and labeiedfplacarded. and are In all respects ,n proper condition for transport according to applicable international and national governmental regulations If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent <br />I certify that the waste minimization statement identified In 40 CFR 26227(a) (if lam a large quantity generator) or (b) (III am a small quantity generator) is true <br />Generatot'AtOffeiroessPrintediTyped Name A Signmige Month Day Year <br />/ ( u Ol /rk— Aid (..:4Ahr let€2, IA I % I et 12t 16 Internet() nal Shipments <br />F-- <br />F_ <br />Impow..-: n Export from U S Port al entryie ii t <br />Transporter signature (for exports only) Date ieaving U.S 'TRANSPORTER 17 Transporter Acknowledgment of Reire,or ,3r miter4s <br />mrstryuhy I PrirritecrTyhed Name Signature Month Day Year <br />I 8-Iq 1 22 Tr-importer 2 Pnn .7y me Signat , <br />(1 <br />1 /I <br />Month Day Year <br />Vz-112- 7 <br />11, <br />1 <br />LI <br />6 <br />< ...,_ ,-, <br />18 Otscrepe c'y <br />I Be Discrepancy Indication Space Quantity Type Residue Partial Rejection Full Rejection <br />Manifest Reference Number: <br />15b Alternate Facility (of Generator) U S EPA ID Number <br />Feality's Phone 1 !I 4-- DESIGNATE t 8c Signature al Alternate Facility for Generator) Month Day Year <br />I I <br />19 Hazardous Waste Report Management Method Codes 0 8. codes for hazardous waste treatment, disposal, and recycling syster-s <br />1 <br />V\ ‘i), 1 t) ‘ S a 3 4 1 a <br />20. Design ii Facility net or Opera Certificabo of receipt of h jo..s materials covered by the manilas L, ncted n ten 18a <br />Pa Name Signal <br />NIL & <br />i Arl Driry. *.r <br />eviou2 i ete, c.>1.A:I/b ,1)/848.514/1eo'81/4 DESIGNATED FACILITY T EPA's e-MAN(FES'r SYSTEM