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UNarFICIAL MANIFEST FOR BILLING PURPOSES ONLY! <br />Please pint or We (Form designed for use on elite(12-pitch) typevm7er.) <br />Pon Approved. OtV18 No. 94 <br />131202-02541145 IProvrousedi0onsmeobsolete . D SIGNATEDFACILITYTO'DESTINATIONSTATE(IFREW�RED) <br />UNIFORM HAZARDOUS 1. Generator lD Number <br />2Pnetof <br />3. Erangerxy Response Prone <br />14. Manifeet7racidnNumber <br />009499659 JJ <br />WASTE MANIFEST CAM00269375 <br />1 <br />877-737-5277 <br />5. Gensatofs Name and Mail'eigAddnnss Generab(s Ste Address (ddiberent Ulan ma0ng address) <br />Pick H Full -Stockton 3927 Clark Drive Attu: Doug Gxose <br />3927 Clark Drive Stockton, CA 95205 <br />Stockton, CA 95205 <br />Gmeadoes Phone: 916 74n-i4Rs <br />B. Tpumpo ter l Company Name U.S. EPAT Number <br />Woslebride Recovery Systems, 1n MM000175422 <br />7.Tnmsportw-2 Canpany Name U.S. EPA ID Number <br />Il <br />Maumee Empress, Inc- H3D986607380 <br />8. Deslgfaled FaditY Name and ShAddnss - US.EPAIDNember <br />$anaco <br />- 1007 Vulcan Road -Haskell <br />Fenton, AR 72015 <br />Fad9"/s Phone: 800-377--"92 ARD981057870 <br />ga <br />9b. U.S, DOT Dewiplon(irdudi'g RcpuShlppg Name, Heard Class, ID Number <br />10. Con'" <br />11 -Tat <br />12 Unit <br />13.WasteCodes <br />No. <br />Type <br />HM <br />and PuWVGrop(darry)) <br />Quanety <br />ynrvd. <br />I <br />1. U91993, Waste Flammable liquids, a_o-s. <br />DOGN <br />331 <br />pY <br />(Petzole— Distillates, Mineral Spirits),, 3 <br />1 51D <br />P <br />d� <br />PGII <br />V <br />V'1 <br />P U <br />I <br />i <br />2 Waste Aerosols, la=m e, (each not <br />D001 <br />331 <br />l <br />X <br />erceading 1 L capacity), 2.1, UN1950 <br />Cf' <br />J1fa <br />I/ <br />/(LW <br />P <br />1� <br />3 <br />4. <br />14. SpecW Harding hISR&Ioo ardAdddiool lNoimalon <br />1) ERG 8: 128; 1010-13429 2) 1004-05510 <br />Dill to Worldwide; Wear Appropiate Protective Clothing; Ea Response# Noxldwide $ecovcaGq <br />Sys, Inc- ; 19R ORDER #227808 - <br />15. GENERATOR'S/OFPER0R'SCMFiCAT1DN: 1hen:bydeclare that the contents dWs consignment are Nu rand accur&*desaibed aboem bYthe PrrpersHppn9(woe. and are classmed, Packa9 <br />. <br />matxed and latMed/placarded. and are in al respects in popercondi6on tor6ampal atcatling to app0ceble ifomafionalard naknal gavemlteMal regulafianis. If expod shipment end 1 em NePrenayt <br />Expo:ar, V ceN(yttutNe contents dihis consi9nmerdconlam to tlretema dtlre etlaticetl FPAMhnowledgmenld Coisent I <br />I cedFyUmIthewage m1n1mtz4m staremml ldenGfied'n40 CFR28227(a) (ff I am a large guanaty generator) or(b) (dl am amp Ruanty yea %1iW is We. <br />cAww"Swemis PmNd.RypedNm S4rato MaNh Day i <br />you/x // <br />¢.a <br />t6.lmemadoal Sh .ems ❑Impcdto U.S. ❑Export Gam US. Pond entTiw. '� <br />_Date <br />leaving U.S.: <br />Transporter sgnreture (Ia'expots only): ' <br />ate' <br />17.T.spwVaAdmoriedpwtcfRecwcf aansK <br />Day <br />OTomsponerl <br />.� <br />M-gediTyped Name $ignaNr¢ th <br />Lw <br />ZtonsFw <br />mWedName Siprw Dy5 <br />,�a <br />1d.Deaepexy <br />18a, Dtscrepawyfid'aztlon Space ❑ 0.*❑Type R¢sidu ❑Par9al Rej¢dion ❑FWI Reje <br />I <br />n <br />Manifest Reference Number. I <br />� <br />U.S.EPAIDNumber <br />tEb.aten¢aFaalry(aGenma�Wi n <br />' <br />J <br />V <br />r c <br />Fadrd} s Phow: <br />4t�j <br />Fd <br />18c SgreWre dACemaa FaGfily (or Genma!oQ Month Bay Id <br />Ymr <br />tlp <br />z <br />19.Hammi aWasteRepot MaWment MdWCodes(o oo6esfo hmrdwswastebmW"dispaWl aWmcyclkvtysamt) <br />G <br />1 2 3. <br />2a. Fadlky Osnercr Operator fufraSan drenzp[ berarJau�eria56mremd by Ore manifest as idedinitemt&1 !� <br />P Slgnafu <br />i' ail Aowih�o <br />131202-02541145 IProvrousedi0onsmeobsolete . D SIGNATEDFACILITYTO'DESTINATIONSTATE(IFREW�RED) <br />