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i eftwN TNvu5 Ll•1 t cC�4 <br /> Please print x type.(FOR designed for use on ellie(12.plich)typeWriwr.) <br /> 7Genmwo <br /> HAZARDOUS 1.GenemlarlONumher FormAppmVed.OMBNo.2U50-Gp39 <br /> 2 Pagel ar 3.Emergancy Response Phone 4.Menefee!Tracking Nu mbar <br /> MANIFEST CAL0o0269375 0 0 8 9 81693 JJ K <br /> s Name and Melflng Address 3- 877-737-5277 <br /> Pick H Put Generamis 511eAddlass QfdimemN then malllng add, <br /> —Stockton 3927 Clark Drive Attn: Doug Grose <br /> Clark Drive <br /> kton, CA 95205 Stochtr>_n, Col 95205 <br /> h one: qlfi 74n—qqr., <br /> r 1 CompanyNares <br /> U.S.EPA ID Number <br /> WorldwideReceve SPs}ems, Inc. <br /> 7.Tner spode,2 Company Nem. CAR OOG175422 <br /> U.S.EPA ID Number <br /> 2Saumce Empress, Inc_ <br /> 9.Designated Facility Name and SNeAddress HJD986607380 <br /> Riaeco U.S.EPA ID Number <br /> 1007 Vulcan Bond-Haslctll <br /> Denton, AR 72015 <br /> FadWs Phone: 800-377-4692 <br /> 9a, 9b.U.S.DOT Deampllan Waling PmperShiNumber ' ARD981057870 <br /> and Paddn Gm da PPm9 Name,FkaeN Class,ID 10.Containers <br /> HM 9 W(� roll 11.iokl 12.Unit <br /> No. Type QuiI WLIVOI 13.Waste Codes <br /> I. IIH1263, Waste Pniat xa.7.nted matezinl <br /> of 8 including paint thinning D001 3311 <br /> or reducing • PSM removing. CE <br /> ate' 4 a9lepound, 3, PG3= <br /> ZWaste:Aeiosols,--flammable, (each not <br /> c9 g eaeceeding l L capncitp) , 2_1Dg1950_. B D001 ' 331 <br /> 3 00. <br /> 3 p - <br /> 3. <br /> 4. <br /> 14.Special Handrmg lnsW d'I antl AdmeonN Information <br /> 13 ERC #: 128; 0912-21643 2) 1004-05510 <br /> Dill to Woriewide; We. Appropiate protective Clothing; <br /> F3 Response* >Borldwide Recovery <br /> Sys, lac. ; W/O� 225839 <br /> 75. GENEeATOR'SIOFFEROR'S CERTIflCATION: Iherehy tle1 11 ma lthemnknLsoflN —elgrvoemare hdyandammlelydescI 111 111,eb Ore <br /> MrRed and labelediplacarded,and are In all respells In proper=Mon(or transport aaordIng to applicable International and national ouemmenkl pmpers.if apart <br /> rt se,kenta and am dI am the packaged. <br /> Exporter.l carlily that the contents of this consignment cordon to free terms of the allacW EPAAchwwledgmenl of Consent 9 regukhons.11 exportshipegent antll am the Primary <br /> I ratify that the waste miembahon statement Mentfied in 40 CFR 201(if I am a larye quantity genamkr)or b}(gl m a small ua <br /> Gene lordOgemrs Pdnl beName 1 9 mitygeneralor)is We. <br /> . `16Signa Month Day Year <br /> 16.International So mans; �LcIs-1 11 <br /> Trans LJ Import m U.S. ❑Export from US. Pod of eruylenC <br /> Transporter signature(tor exports aNy): Dale kering U.S.: <br /> C 17.TmnspoderAdmowbaI enlMRaceiplofMaleriels <br /> C TranspaqPP oaCyped Name <br /> h �' /IJV Gr_2 CU2 rnP� Slgne°"e �• / ' Month crag Year <br /> Q Trenspaler2 Pdnkdrfyrod Nems <br /> Monte Day Year. <br /> 1 16.Desoepancy <br /> I 1be.Discrepancy mdlcation Space ❑ Quandry ❑Type ❑Residue <br /> ❑Partial Rejection El Fort ReJedion <br /> 18b.Alternate Fadsty(or Generaler) Man6esf Relarenca Number. <br /> -� U.S.FPA ID Number <br /> U <br /> LL FadAty's Phow <br /> w 1&SFpmture afAltemae FacMy(er Genemlor) <br /> Z Monro Day Year <br /> H19.Hazardous Whsle Report Management Method Codes(I.e.,codes for hazardous Wada ireatmanl.disposal <br /> 1, 2 end <br /> wp racycOngsysoems) <br /> 3. 4. <br /> 211.Designated 111 Diner ar Operator.CeNficaeon of recelpt of hazardau=Weis covered by Ibe manges!except as tided N Item iea <br /> Prenledflyped Name MoenW. re <br /> Month Day Year <br /> EPA Form 6700-22(Rev.3-05) Previous edigans era absolele. <br /> DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />