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0 OSC. 00494. 1 '95 <br /> EES-4 Form Approved.OMB No.2050439 <br /> Please print or W.(Farm deli ned for use on elite(l2-pitch)typewriter.) 2.Pegs t al 3.Emerge Resyar►se Pt'o^° 4 wnirestiTradclnq Number <br /> UNIFORM HAZARDOUS 1.Generator ID Number 1 -i—bbo 'Z4-934Q <br /> WASTE MANIFEST C AL X00 31'Q'�3 Generators Sin Address(+f dent 1t+an nraSmq-address) <br /> S.Generators Name ar10 M 1 0 t <br /> t mea fiL'1�f1J <br /> IDZ.2 r /'1� <br /> Qtr Q r�/ -�✓ 7 U.S.EPAtq Number <br /> Generawrs Pte' !413262 <br /> s.Trte�EV RtaREEN ENVIRONMENTAL SERVICES <br /> U.S.EPA1D Number <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> a.Designated r CAD980887418 <br /> 6880 SMITH AVENUE <br /> NEWARK CA 94560 <br /> Fadi s Phone: 1f1.Containers t1.7otal- 12.Unit ,3 Waste Lades <br /> gb.U.S.DOT Descrj (mdluding Proper <br /> Shipping Name.Hazard pass,ID Number, No. Type QuantityRM 1n�vd. <br /> and packing Grorrp(d any)) <br /> [QUID TT 5Z <br /> o ON-RCRA HA RD US WASTE=, 5200 <br /> 4a Qt 1 � <br /> W 2 <br /> 2 <br /> W <br /> r7 <br /> 3. <br /> 4. <br /> I'ROFII E #rm endAINVOICE <br /> dditlonal mrormation # l <br /> DOT ERG#171 WEAR PROTECTIVE-CL OTMINGthe proper SALES ORDER # <br /> ng ad <br /> sornsMomfullyardaccui <br /> 15. GENERAmb PlarOd d GandnaAC dl N-I hsmby demOW h1ttn for transport sowcon to 4r4amatl and�tl gdcremmentrl regulatloru If export ahVpmenS a dclassified. <br /> I aim the PAmer�f� <br /> Exporter.I can ly owtents of this tnnsgnment conform to the arms (7te attached quar Bone dgm <br /> erd of Conserv <br /> ice ' minimization slanment Identified in 4d CFR 2g227ta)lM I am a large gtun6ty generator)ar(b)(d I am a small quantity genaretod is true. -MonthDay Year <br /> OCC <br /> r Nam• - � �. {{----�� <br /> ,fi.Intamationet Shipments ❑Import Ia U.S. I__l Expod from U.S. Part of antylexft <br /> Date leaving U.S.: <br /> Trensporter slgnatum(for expoRs only): <br /> 99 17.TrwsPortsrAdarowtedgment of Receipt of MstwWs Monyr O Yee <br /> � Tran ,iter 1 PdntadlTypad Name Sira=n le <br /> �} <br /> Mor11h gay Year <br /> rnature <br /> 2P"Lyped Name <br /> 1s.Discrepancy ❑Partial Rejecdon 0 Full R*rtan <br /> 1 ea,OL rr"noy trdil"Space ❑ C m ndty ❑Type <br /> ❑Residue <br /> Manifest Reference Number: <br /> U.S.FPA SO Numter <br /> 18b,Nnmate Facility(or Generator) <br /> [1 Meath Day Year <br /> U. Fadlilyrs Phone: <br /> W tac.Signature of Amman Fadily(or Generator) <br /> Y <br /> 19.Hatandoue Waste Report Management Method C0003(.e..codes for hazardous wash treatment deposal and reading systems) 4. <br /> 2LU <br /> 3. <br /> 1-1 <br /> ex noed in Item 1Ila I�,r a, Day Year <br /> 20.Designated Facility a(or Operator Certifipion o1 reeeipt of ha,:ardous materials covered at <br /> vered e t re <br /> PrtntedrT <br /> EPA Form 874(1.22(Rev.J-51 Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 10264,0818 <br /> d2 4.08 $ <br /> , F� r <br />