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.please prinl'ortype. :q a designed fo mjg eUta�l pitch) -'Mfr <br />Farm Approved, OMB Pf0:2050-0038 " <br />UNIFORMHATJtRDOIf& 1. Generator ID Number : "V2Patle <br />5 <br />1 of <br />3. Emergency Response Phone <br />4. ManhotTracking Number <br />WASTE � NIFEST L IU1003 ' .c° <br />16 371�a7St <br />_017145,319 <br />b{. a andMOrigAdd"� Generator's Site Address (IfdMferentthormolllrtgeddreas} <br />1513RElECK RE RCE; RECO/" AJ &6i0— AJ ;� <br />1IM INDUVPJAL<Elk <br />STOCKTON, CA 19 <br />l3iaiidtlr's <br />U.S. EPAID Nurser <br />6. .. t t Nemy:. u.... <br />R_i1M�F I?APlRr7NAllfwPfiAL SERVICES <br />CAODs444if3.36F16 <br />Transporter 2 mpany Nene <br />tt S; EPA ID�IN or" <br />Fadlt e'and;SiteAddress <br />Vl`OLJA ES TECf1NUC.ptE ;CWTIONS <br />EPAIDNfarYtal <br />ih7t�9Q0# 4 <br />4125 tiEt+ib1LEY SIfiEEI <br />. <br />. .. MC!^iMMNG. f^.A wimi <br />.... 241 <br />Fa s Phone8t�.. <br />_ <br />ga <br />" "9b U -S. DQi Description (includingProper Shipping Name, Hazard Gass, ID"Number, , <br />to. Contafr>arti <br />- <br />f -. Total <br />12: Onit <br />13 Waste Codes <br />Paddrrg Group CO -01 .-. <br />Na. <br />. <br />Quantity <br />M.Noll <br />i+FTA}lY IiAZPsRt7t1U3 54183TAnlCES <br />f14t1 <br />P <br />134 <br />t>c <br />Q <br />SQL�A @IQ3 �, K�C3tll �CFIORAAIUM'r k:EAO}. <br />�/ <br />M <br />,rr <br />LU <br />0 HYPOiGHLONTE, <br />;,tfetdTj <br />flirt <br />Of <br />�,�✓ <br />P" <br />481LU. <br />• <br />.37-7 . <br />4: <br />14 SpecAl Har,- N:Instructrons andAddihonai Information <br />ijPRt iL t'Rt3#ti! 9}P ERGM74 3 <br />E lir_ �©el�` EPftl9tQIdME: ' <br />_ <br />15• GENERATOR'S/OFFERAWS CERTIFICATION- t hereby dedara that,the cotiterds of tbls;eonsignment arafully and accurately described above by" proper shipping"name, afd are classified, padragad " <br />marked and labelecUpla6irded: and are in all respects in proper condition fut transport according to applicable international and nationat gavemritertfet"regulatlons. If e*rtsh pment and.l am•the Prmarj( g <br />Exporter. I ceirtity that the contents of this consignment conform to the term& of the attached EPA AcknWsdgmentof-Consent <br />I cerci that the waste minimization statement Ideklied In 0 262.27 d l am a large uanti generator) ar, di am a sma6 uen br is.tna <br />ty fa)( r9 Q ty9 ) . @}� q titygenera ) w <br />Gene for ror's.I2dgtaflfF Name SlgnaWre <br />nttr <br />F-❑ <br />Import to 11.5. EicportfromU.S Port of entry/ewt <br />Trarreporleraignature(for e>gr6lts'only). Date Ieaving U S.: <br />W <br />1.7.Tiar porterAduli aidgmerd.oJ "otMaterlek <br />F' <br />ris r1 F ted/TedSI9n <br />t . <br />MonthIL <br />pay yplr <br />Month*71 <br />TTahspo(ter 2 Pdn yppt: Name ; turA <br />1"B. Discrepancy <br />tBa. Discrepancy Indication Space _ ❑ Quentlty ❑Type"' ResiduePartial <br />�--g <br />❑ ajec6orr" Fu6 ee6on_ <br />R F—F R <br />Manifest Reference Number <br />U.S. EPA ID Number <br />; <br />' <br />1 Bb. Alternate Facility jar Gene(atorj <br />4. <br />Fe�ltysPtwa4 <br />Msrrtlt .flay <br />sit' <br />a <br />OE SfgnallmoFAlOwnate Fadlity (or Generat' <br />Zy <br />1'9:'Hamrdous Waste Raprxt ManagementMethad Codes (ke iw�as for waste treatment, dlsposat ard:recyiling systema) <br />�1 <br />? <br />3. <br />4. <br />y <br />,. <br />20. DesignatedFadltty Owner or Operstgr. Ceffao <br />mot reeelpt dhezamdoru, eredbj+Uie mardtest exceptae 48a `. ` ' <br />Pjia�ams <br />- . " orttlt Year <br />DESIGNATED FACILITYTON�6it i <br />osolete <br />EPR Forrri 870 (Rev. a preMWlons.areb <br />... <br />