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SO punt or type, Form designed for use on elite:0 2-pitch)-typawrbr.) Form Approved, No,2050-9039 <br /> ufuIFURM HMRDOUS 2-Pamlof 3-EmergehcY-Responseftome 4.Mnlle*l Ta�llnv Humber <br /> WASTE MANIFEST `00269375 -�E;1 .f In rltl r <br /> 5 9 L�-97 7; 8 2: <br /> S.Pe"Wor's Name and Maiio Aft�" GeneraWs Silo Address Or driapront jha� 119 2 6 GB.F <br /> PICK-N-PULL fkG-. <br /> 3927 CLARK <br /> STOCKTON. CA 95zwe-ni <br /> Generate?&Phone'. <br /> 'B--rans <br /> Transporter I Company Name <br /> A ID NW1npe <br /> CHI Remling service It-te <br /> 029761 <br /> ' <br /> Tf­r4ns—poder 2 Company Name Nam, —S <br /> U.S,E r <br /> 8.Designated IXlily Name and SiteMdress <br /> S. <br /> CRI EPA ID Number101 k1men 3t iQf- WIR000029761 <br /> F UDZ� W041411,-TW <br /> ft. 9b.U.S.DOT DB"Uon(inclUdIng Proper-Shipping Nam,Hazard Class,ID Number. — <br /> and Parking Group(If anyD 10.COhlainers 11.Total <br /> 12.11M1 <br /> WW401. Waste Codes. <br /> No. Type Quantity <br /> NOtFRC'" H.O.Mdou-9 *8S.71Y4 223 <br /> 7601 P <br /> �N§ copy-is Youi <br /> OF RECYCLING <br /> J. <br /> 14.Special Handil ln,,..,.ns and Additgnal <br /> Information <br /> tfive Ch3thinq and.F-Yew"". 9A -OILY Aesorissw EAG'.: 9-1 <br /> 15. GENERRATO OFFEROR'S CERTIFICATION: lh8rebydedamihaithe c*Atentsofthlsconalgm&ntam <br /> Maftdandlabal�dypj NNY and MD01](alelY deWkd above by the proper shipping name, We�G[Mrmd,packa., <br /> rdad,and we In afl MIMUS in proper condition(Of PaM;POd&OVding 10 applicable mtOMMonel and nakmol governmental regulations.I(export shpMent and I am the Primary <br /> Exporter,I cergo that tahueountonis or this consignnwt conform 10 the jgmjs of U attached <br /> That the EPAAck6owledgment of Consent, <br /> waste minimization statement Identified�n 40 CFR 262.27(a)(if 18m a large quank gonerator)at(b)Of I am a small quanflty generator)Is true. <br /> PrInW6Typed Name Slgrradxe <br /> Month Day Year <br /> Transporter signature(for GXparts only): port from U.S, Molentrylexil! <br /> 17.Transporie AdTcMedgment of Racelpt of Maledals Date leaving LIA <br /> ar <br /> �M�DrOh '011, Ya� <br /> 2 1 f <br /> a� T Prinledffyped Name <br /> sr <br /> M <br /> Tfansporter Prin edfroed Nffne 4 y <br /> F5 Signature Monlh Day Year <br /> 18.Discrepancy I <br /> 120,Discrepancy Indication Space ❑ Ousnifty ❑Type, ❑ResIdje <br /> 1:1 Partial Rejecilm Elull Rejection <br /> 180.Anernale raduty(or Generator) Manifest Reference Number'. <br /> U.S.EPA ID Number <br /> FacAly's Phone:' <br /> 1:1111SQw, <br /> LLJ <br /> Month nay <br /> 1v4147qt00M&Waste RODOAManagarneLmMethod codes ror <br /> LU hazardous =2"aawl,disMal,and MrYcllng Systema) <br /> 20,Dos V481edAledrj), <br /> rrarre dr Name or 42erelw-CW91rell-n of roe:Pt Of Nardou. <br /> rnstar'ffis CoVered by lh&MgWqst <br /> E114 FQfM B7C 0' 22(8. ed <br /> _,96) Rfevlafrs <br /> ns are obsolete, <br /> 'd 96so N <br />