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F€7rnt Approved.OMB No.2050-W39 <br /> phase print or type. <br /> UNIFORM HnARDOOS 1.Gar orator ID Number 2.Page i of 3.Emergency Response lc{c 4.Manife�tTraelitngNumb"19921413 �� <br /> fPlASTE WIANiFssr CASDOOM71 1 • O <br /> 5,GeneraWs Name and Mailing Address Ganerato€'s Sits Address(if ditterent than malting address) <br /> Canary.Renevi Cap <br /> Stockton, CA V6M <br /> Ganerators Phone: U.S.EPA tD Number <br /> 6.Transporter 1 Company Name <br /> ADVANCED CHEM�4L TRANSPOKFLMC Cf1RtlQQI�lOb4(� <br /> 7.Transporter 2 Company Nama `; U.S.EPA ID Number <br /> 8:Designated Facility Name and Site Address U.S.EPA 0 Number <br /> S ycun Teclx�ag(e SIA C.V. . <br /> Andadory hill3W2 Cot.Wife Redondo <br /> Tijuana, BC <br /> Facility's Phone: 6Z4 4455 <br /> 9a. 9b.U,S.DOT Description(including Proper Shipp ag Name,Hazard Was,iD Number, 10.Containers 11.Tola1 12.Unit 13.Wasla Codes <br /> HM and Packing Group(If any)) No, Type Quantity wtivot. <br /> 'UN2924,Waste Flammable IlgVids,corrosive,rLa s. L3F 212 D001 D002 ' <br /> o X (Metba no),Polassiuni Hy(hodde),3{8),PGR Fam FW5 <br /> z 2. <br /> 3 <br /> 4. i <br /> 14.spacial Handling Instructions and Additcnal Information Pr*d(UE{ ff 58M DGtCunwi11f 9 <br /> 1)ERG#132; 253 C S- 7 X I C J Coxbot . <br /> 15. GENERAF4R'SIDFfERQR'3 CERTIFiCRTlON:I i eraby declare that the contents of this cansiglnmenl are tuliy and accurately described axva by the proper shipping name,and are dasslfiad,packaged, <br /> marked and labeled/placarded,and ere in atl respects in proper conditlorefor transport according to appliohle international and Rational governmental regulations.li axportshipmant and I am lire Pr mary <br /> Exporter,I certify Met the contents of this consignment conform to the terms of the attached EPAAcknowledgmeni of Consent. <br /> I certify that the waste minimization statement identled in 40 CFR 262.27(a)(f t am a large quaaUly generator)or(b)(it I am a small guanlity generator(is true. <br /> GeneratotslOfferofs Printedffyped Name Sgnatura Mon h Day PFeTar <br /> w .I,/ 5 <br /> t6.intama oval Shipments D linparl to U.S. ❑Export Gam U.S. Portof en <br /> Transporter signature(for exports only): Dato leaving U-S <br /> 17.Transporter Acknowledgment of Receipt of Materais <br /> Month Day Year <br /> Transporter 1 Pdn d170 PSI' <br /> �ypad Name Signature <br /> Transporter 2 PrintediTyped Name Signature Month Gay Year <br /> 18,Discrepancy <br /> 18a.Discrepancy indication Specs ❑Quantity ❑lm ❑Residue ❑Partial Rejection CI Full Rojedion <br /> Manifest Reference Number. <br /> 16b.Afternate Facility(or Generator) U.S.EPA ID Number <br /> w FaraAty's Phone: Month Day Year <br /> 18c.signature ofAltonmte Facility(or Generator) <br /> 4 <br /> 19.Hazardous Waste Report Management Ntethod Codes(,.a.,cud9s for KvAtdow v+rote traahners disposal,and recycling syatoms) <br /> WG } 2. <br /> 3 C <br /> 20.Designatad Facr6ty Owner or Operator.Oertificatlon of receiptof feaza*ue materials covered by the manifest except asn—cle.0 in Item 18a WorlF Day Year <br /> PdntedlTypad erns - Serrature <br /> EPA Farm 8700.22�Rev.12-17) Previous editions are obsolete. DESIGNATED r-ACIC rtd 59*mA PesT sysTEm <br /> i <br />