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Please print or type. Fc(m Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Gelrerata ID Number 2.Page 1 of 3.Emergency Responifest Tracking Plumber WASTE MANIFEST CARR }0220046 909 984-998.1z: 017231598 FLE 5�ryQ� 1trl'�j]@ aid �p`�ys Generator's Site Address((if different than mailing address) L�Kff �1i:1.�.t� 1d7. CARE FAIL IT: (0. 557) 770? SOU'17. fiiUST.I.-N I�OAX, 7707 SOUTH AUSTIN ROAD (attn: 11- whistle S` Ly)a:ETON, CA 95215 ( -Eki:r:uarP STOCKTON, CA 95 215 Generator's Phone: 900 461-7vA4 6.Transporter 1 Company Name U.S.EPA ID Number INDUSTRIAL WASTE UTILIZATION. : XG.- CAD9805952293 7.Transpce-ter 2 Comparry Name U.S.EPA ID Number 8.Des! hated Facility Name and Site Address U.S.EPA ID Number COSBY &- OVERTON 1630 V- 17Th STREET LONG BEACH, CA 90813 Facility's Phcane: 562-432-5445 CAD028409019 ga 9b.U.S.DOT Description(including Prcper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Tota! 12,Urit 13.lNaste Codes HM and Packing Group(if any)) No. Type Cruantity Wt.Plcl. 1. UVIuol, a e Tlealetne, lux Como,. n.o_s_ D010 D024 o tselenium ssulfide/insulin) ,. 6 -w: PGIII ---- 0 z 2. XQ, U93249, eMICTRej solla, toula, D 31 � � r,_ca.s_ (vsarfarinjnitro�,7lyce*irt tabs) , !�_1, _-_ �- PGIII G 1DF (3 9 P .1 .<, _ tie t not 331 I 3. emeeed.inal I L aapac±ty) a-2 ! - --- ry-� 4. 1 ------- --- 1 14.Special Handling Instructions and Additional Information 1) loop et pac3•_ med±aines li du-idjagp##124280; ERG 4: 151. 2) IT m`.di.ei.nes solid ERG 4: 151 3) .inhalers-124181; ERG $: 126 i� G,5 3 15. GEN ERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fuXy and accurately described above by the proper shipping name,and are claspfed,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport accor&g to applicable int��b)Cffg tional and national governmental regulations.If export shiprnerl and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms,of the attached EPA Acknowledgmanf ot. I certify that the waste minimization stat ment identified in 40 CFR 262.27(a)(if I am a large quantity generator) a sniApantity generator)is true. Generator's/Offeror's Printed/Typed Name Si nalur Month Day Year ICE 1AA 16.International Shipments ❑Import to U.S. ❑Export fro S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: K 17.Transporter Acknowledgment of Receipt of Materials Uj Transporter 1 PrWed/Typed Name Si a Month Day Year U) Transporter 2Printed/Typed Name Signature Month Day Year F 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Afternate Facility(or Generator) U.S.EPA ID Plumber n U 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 a 1/* 2Hp �D/ 4 j1 i� j 20.Designated Facility Owner or Cperator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 180n 1 Printed/Typed Name / Signatue Month Day Year EPA Form 70 - (Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM