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T <br />t_ <br />Please 0r Fom N0,2050{039 <br />r Inc. 1138 <br />1 m{-0:100 <br />, <br />Oufk $top lfrrkstgr <br />X65 Elrrdlrr Ro.d <br />a I I <br />UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />IUn 01581 <br />fnc. <br />clrocooltr;2 <br />53?-7100 <br />gt,cA 90u22 <br />10. Conhiners9a. <br />HM <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, lD Number, <br />and Packing Group (if any))No.Tvpe <br />11. Total <br />0uantity <br />12, Unit <br />M.IVol. <br />13. Waste Codes <br />FFNGtD{UlOS, Gasolfr3 ltlrtxrs, 3, EGi ff.x <br />f16r <br />iII <br />s6l <br />2. <br />14. Spocial Handling lnstruclions and Additional lnbrmation <br />llol: 128G.euna e Etas <br />EEII s 366099 <br />([EICeIe Gil: 6923? <br />m t1:',E;-il 1 <br />Exportel I certily that the contents of this consignment conform to thq terms of the attached EPAAcknowledgment of Crnsent. <br />I certiry that th6 waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifl am a small quantity generator) is true. <br />Eokc, <br />UJzur(9 <br />I t L" <br />i- <br />= <br />E tmportto u.S.E exprtfrom u.S.Port ofentry/exit: <br />Date leaving U.S.:Transporter signature (for exports only): <br />16. lntornational shipments <br />17. TransporbrAcknowledgment of Receipt of Materials <br />fi,-.,.,L -Thrres {f,^*3 d**^^r, <br />Monh Day Yoar <br />I .BltLlaq <br />TransporEr 1 Pnnted/Typed Name slgnature <br />18. Discrepancy <br />18a. Discrepancy lndication Space Partial Rojection Full Rejec{ion <br />'18b. Ahernate Facility (or U.S. EPA lD Number <br />ResidueQuantityErr* <br />Phone: <br />1Ec. Signaturo 0fAlternate Facility (or Generator) <br />I <br />MOnn uay Year <br />19. Hazardous Wast6 R€port Management Me&od Codes (i.e., codos br hazardous wasb troatrnent, disposal, and recycling sysbms) <br />Oflner or Operator: Cerffication of roceipt of hazardous materials owrEd tho manifost nded in lbm 18a20, <br />=c,f <br />Ek <br />=(, <br />frct <br />I <br />Iar€TRANSPORTER138/3534306