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1- 5-Ij <br /> P1caseprint cre.(Foran de81gned17,"1 ort elite(12-pitch)Vpiawlter-) Form Approved.OMB No.20544439 <br /> UNIFORM HAZARDOUS Generator ID Number <br /> 0 0 0 1 9',J 9 <br /> WASTE MANIFEST "t ) 3.P 4 4 SKS <br /> 5.GuneraLo?a Name and Maiing Address Generalor's Site Aedriass(if different than mailing address) <br /> DELTA TMAK ShU,� U-1r, <br /> 10161 SOUT[I HAJ;1,Ati Rf/ PO Flog 310170407'y <br /> I�RENCV CAMP CA 9)'M <br /> .Generators Ptone: <br /> G.Transporterr .1 Company Name U.S.CPA 10 Number <br /> "WETY—KLEEN <br /> 7.Transporter 2 Company Name U.S.EPA fD Number <br /> B.Designated Facitily Name and Site Address <br /> WETY—KUFN SYSTEMS, INC. n .U,S.EPAID Number <br /> 6000 88VISTRYET <br /> CA <br /> Facility'r Phoria: CAOOOOG84517 <br /> 98, 9b.U.S.DOT Description(irducling ProperShipping Name,Hazard Class,ID Number, 10.Containers 11 Total 12 U0 13 Waste Codes <br /> HM and Packing Group(d any)) NO. Type Quantity W11M. <br /> x 1, WAVU PAINT R&TAATEID MATERIAL, '3, LIN1263, P F00 FW D001 <br /> 1?G I.L, (ERG 4 1.2 3) 7, 2 4,NAL F005. 00 3, DO() <br /> DO Le,DO 3 5 DO 36, DO 9, DO 4 0 D03 T43 T03! 212 <br /> LU <br /> 4. <br /> 14.Special Handling Instructions andAdditbnal Information <br /> TRCW0866Z191 0034C)O?M47 0000370930 0729 25 <br /> of this consignment are fully and acourataly deScrtTted-eb-oWby the proper shipping name,aM ore dassilled,p~, <br /> 15, GENERATOR'WOFFERORS CERTIFICATION:�VWI thatfife�,(!j <br /> marked and label4placatcled,and are in all respects in proper condition for nmpon aoconcling b appFcable inbeemational and natlorial governmental regulations.Ifexport shipmont and I vnft Nrnafy <br /> Exporter,I certify that the contents of this consignment conform to the terms of the aflached EPAAcknowtedgmeril of Consent. <br /> I certify?raphe waste MinimizaliOr statement identified in 40 Cl 262.27(a)(if I am a targe quantity generator)0, P(if[am a small90941%ganaralar)is true. <br /> a <br /> rGG-`en-e,at2V,0fferor`&Printed/Typed cNama � r Morth u4 Year <br /> I -Cl 17 <br /> ;A 16.Inlemstional Wpmants 0 <br /> I- ElImport taus- ❑Bpcirl from U.S. Pad of en 1exi1: <br /> LZ Transporter signature(W exports only): Data leaving U.S.: <br /> 17.Transporter Admoorledgwrl of Receipt of ftMat > <br /> Iranspoderl!— Mwth Day Year <br /> PnntedYTyped Name Signature <br /> Z Trilinsporlef 2 PilnlenpW Name month Day Year <br /> it - <br /> 18,Discrepancy <br /> tea,Dsc4spancy fridicabon Space 11 Quantity El Type ❑ Full R"' n <br /> Residue ❑Partial Rs�jaclion ❑ <br /> Manifest Referenoe Number: <br /> lgb.AllemateFacAity(or Generator) U.S.EP'Alb Number <br /> 01 <br /> rQ F3ciljys Phone. <br /> T8�Signature ofAlterflale FadlAy(or Generator) ln Year <br /> wf <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling somt) <br /> LLI 4. <br /> 20 Designgled Fadilty Owner or Operator;Certification of receipt of hazardous materials covered by the man ita sl exce p3 qs noted in Item—10— <br /> o� <br /> PrintedIT 7 Sig Month Day Year <br /> 77 <br /> T10 'd NP- Uq@pJ—AqjjeS—W0EE <br /> 899-9 TZO/600d OSZ-1 9TG�98SKG <br />