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("�+r�"�.""..I�r.�--n.-•1 "r".—"�T'�"""n �.�} ��•�.,.� y.-�.,.�.�,-��'r' r"""'^'�.+'r'*„T^n'°;"*'^'!'�. 'w:n4.'�,r,.+s.�—+,^--�•.'"^en�^...nr• -..rT�..+;!n <br /> r 2 <br /> kd. <br /> Please piiht br type.:. Form Approved.OMB No 200 0039, <br /> 1 Generator ID Number 2 Page 1 of 3_Einergency Response Phone. 70 , <br /> Marafe raclang Number <br /> UJ <br /> k UNIFORM HAZARDOUS •' Q 7 <br /> )HASTE MANIFEST A. Q-Q. 'Q T- 4 Q 1v / �� <br /> k 5.Generators dame and Mailing Address. ; Generator s Site Address(d ddferent than mating address) <br /> YRC t=lieaght y� `RC Freight.. <br /> 1099 Roe AYES '1�Q�:�4�t�d 720$ 0.9t <br /> �.: hrertand P�Ht5 8t Lathrop CA 95330 <br /> k 4nerafors Phone <br /> 6:.Transp„ r 1 CompanyNamer f U.S EPA ID Number <br /> PAiR1C?TE1�lU1ROhfM6N'1At SERY10E=S C '� 3 :.$ <br /> r� -T-Transporter 2 Company Name a U.S.:EPA ID Number <br /> 8.Designated Facility Name and Site Address U;S.EPA ID Number ` <br /> CROSBY&.(WER rON <br /> 16311 W.17TH 3 E� , <br /> LONG BEACH'. <br /> 8081;3 a <br /> k Fad6ty s PhoA Q $ A Q . <br /> ga .9b U S.DOTDescripkon(tndirding Proper Shipping Name,Hazard Class,ID Number 10.containers 11CTotal 12 Unit <br /> �. 13:Waste Codas'; <br /> Paddng Group(if any))_ No. Type Ouanttty :WtNol <br /> Irk <br /> !Mort-R;CRA Haxardouy ftste.Sts1Ed(sorbent and debris vyith 8gmery 781 <br /> Add)' 0.0 t <br /> Z.. 2 <br /> i ; # ` <br /> k <br /> k: <br /> t9andg dristruc6ons and Additional I formation Prafll I1I0 5Y#18 J 11-#:9-Q03 t <br /> 73� - - <br /> r <br /> 1 <br /> b �� Q' s Irvear app <br /> ro.riate PPE when handlingwaste.JOB*'.: <br /> 15. GENEF?ATOR'S10FFER0R-S,. ERIIFICAWN:I hereby declare that the contents of this consignment are fully and accurately described above.by.the proper shipping name;and are dassfied,packaged <br /> marked and labeledlplacarded,Aid are in all respects in proper condition for transport according.to applicable intemationaland.national governmental reguleflons If export0lpment and tam the'Primary. <br /> Expbrter,I certify that the contents of thiS:consignment conform to the terms of the attached EPAAcknowledgment of Consent <br /> It. I certify that the waste minimization.statement identified in 40 CFR 262.27(a)(91 am a large quantity.genera (b)(if I smail.quantity generator)is true <br /> k Geh6rato Offerors Pnrite'dlTyped Name. Sign <br /> Da Ye <br /> diha <br /> Win ationa'. ipments: <br /> F, Jetport U S ❑ tram U S.. Part of entrylexit' <br /> Tramporter signature(for expbrts;only)i Date leaving U.S.: <br /> 97,7ransporterAcknowledgmentof Receipt of Materials <br /> Uj Transporter 1.Printedrtyped Name ature r Manlh'. Dalr : year <br /> - { : {{ r <br /> QTransporter.2Print ype:Names nature Month Day. Year . <br /> 4 <br /> k •181,1Jiscrepancy. � :_ t �'•, .. <br /> tee Disaepancy Ind(catuxi;Space Quart : QTjpe' ❑Residue. ❑;Partial Rejectlon ❑FuM RejecNort <br /> n Mandest ReferenceNumber FrSrtE <br /> gib.AllerttateFact jorGeugraator) r1rRF}tiKtNC•kDWA91h A4 o $4fApA �y�tp6fryFACJWY:UNDFR <br /> .J _ <br /> LVPOSAL.TRFa'iMENF OR REt1SE.CROSBY A.-OVfRt - . <br /> U �,... j�ERhffrS ORANTl1YTO T}ff1.i.By TtM DNTARTMENT OF"0... <br /> U7'$ThNCa GCQNYROI I OCS [:Sk. <br /> AL FROT,E(.+70,1 ltiu' rY r�r!' �it�t'4l E`y?rH TFW PRO SSIOyS 01 <br /> F rQi Fsdlity`s Phone vJrm THE FNVOtoNMEtrr ON AND PECO'i'EB! if a. .` off 2 rC San 1ViT i AtPf '041 t <br /> -18c.Signature of Alternate-Facility '.. Axe s'1`ATE.REGvuTtO�s CR.• r i:: rr ..O.ri.. Day:,:. Year. <br /> �, r..., ,. .. .. ;:t.FERA .A A A,1'Tr1T RFS't?=r yrT'� �1 . - , <br /> k, N ,19.Hazardous Waste Report Management.MetAod Codea(i e;Codes.forlhazardous waste treatment,disposal,and recycling systems) . <br /> t....:. 20.Designated Fadldy owneror bpetaEor.CerBficeti0mof receipt.of f fazardata rlreterlals covered byihe manifest except as ndnd' <br /> em <br /> 18a.. <br /> I flrntedliypedNae Signe Month Day. <br /> EPAF.o�m 870 '2 v.12-1 Preyiou's,editiortsafeobsolete, _ DESIGNATED EACILITYTO GENE OR <br /> E <br />