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OCT-27-2008 18:27 CITY OF LODI 209 333 6710 P.34 <br /> Pie s6 print or type.(Form designed for use on elite 12-pdchoorlter. • Form Approved.OMB No.2050-0039. <br /> UNIFORM HAZARDOUS 1•Generator 10 Number2 Page 1 of 3.Emergency Response Phone 4,Mal lhal Tracking Number <br /> WASTE MANIFEST b(11 SKS <br /> • qE <br /> S.Generators Noma and MallingAddress Generelors ShaAddross(if dlKerenl than mailing address) <br /> Generomra Prions: ',r}o•--i'3' •—hrs='r � <br /> 6,Transporter 1 Company Noma U.S-EPA ID Number <br /> SH'E"r' uE,d c?3TFC!8• INC. ti:R0i0Gr5� 2Cr <br /> 7.Transponer2 Cornpalry Name US,EPA ID Number <br /> 8.Designated Facelty,Name and Sha Addressa,tSl:I,.JEEt4 SYR-MI'S, V-2 (,t.(,76iC+ U.S.EPA ID Number <br /> Li'1�4r r''S r VI REF] <br /> Sr1CfiArEI;T� C-: 95S?B <br /> Fadi s Phone: <br /> "r 3 a—wd+5'�91:5 CACC't'00$4:+t 7 <br /> go. 9b.U.S.DOT Desorption(nduding Proper Shipping Nemo,Hazard Gass,ID Number, 10,Contalnere 11.7011111 12.Ung 13.Woam•Godae <br /> HM and Packing Group(aany)) No. Type Quantity WtNol• <br /> a 1r AiAR7i1LiW' uip"'il E: ' ,',rouID1 I;. u. OF C :1035 <br /> � q ;.:,a .,^,'za �•— y ;n+-r?y r ,j i rr... <br /> z 2. <br /> W <br /> 3. <br /> 4. <br /> 14.SpecialHandgngmstme send Addmonalmfomaeon 5tf i'Fl: ki'.?8 29 i1 QC37FB2944 0000*3%77 0740 2v <br /> - � T _•p Y,� n .Irr 9cfi r. r^ c ^+Y <br /> 15. ,ERA70R'SI FF R'S •I1R y CATIO :'I nareby edare dlallhe cmlena of H conslgnmmlt are filly and accuretoly deembed above M'the Dmper shlppklg name,erd ere dassitied,paokeged, <br /> marked and labeledrplacarded,and ara in all mp"In proper Condition for transport aoiamng to applicable Intamallwaland national governmental regulations.If export shipmenland I am the Primary <br /> Expoder,I certify IKEA the Contents of this conslgnmeni conkam to the terms of the ofisared FPAAcknoWedgmem of Consent <br /> I certify that the waste minimization statement Identified in 40 CFR 26127(a)(6I son a large quantity gonaramr)or(b)it([am a small quantity generator)is true, <br /> Ganoremrsl0lremrS PdnlednWed Name SigneWre Month Day Yeaf <br /> J 16.Intamefival Shipmank 14"• <br /> F ❑Import m U.S. ❑Exporlfrom us. Pont of emry/e1dC <br /> z Tienslwdersignature(for axpons only); Dote leaving U.S.: <br /> W 17.TransponerAcknaMedgment of Receipt of Materials <br /> C Transporter 1 Pdnfacayped Noma Slaivare i '( 'hi Month Dayy Year <br /> 1 C—" <br /> ,fir:\: . / 'i r (•...'t 1'"4 <br /> ay �-• "•''.:• ,� Month Day Year <br /> Trenepo r 2 Prints atl Nemo a S`ig`naWfB—_••^_. <br /> 18.D'scepancy <br /> Ida.Discrepancy Indication$pace ❑ Quar uty ❑Type ❑Rest&, ❑Partial Rajeotion ❑Full Rejector, <br /> hlanifeal RefMence Number. <br /> 181b.Alternate FxIIV(or Generator) U.S.EPAID Number <br /> J <br /> V <br /> LL <br /> Facility's PNne: <br /> ujj 18c.Signature ofAranvo Facility(w GenaraW Moron Dsy Yaar <br /> Q <br /> 2 <br /> ro19.Hazwfta Wavle Report Management Method Codes(i.e.,codes mrhazamous Wil tr'eaonenl dlaposa6 and racycling ayslems) <br /> i 1. 2, J. x. <br /> 20.Designated Fadllry Owner or Operator:Certification of r oelpl of hazardous materials covered by the manifest except as NW In Item 18a <br /> PdntWyped Name glMmra Month Day Year <br /> EPA Fom18700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />