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Form Approved.C)M8 No.2050-0039 <br /> Please print or type,(Form designed for use or,elite(12-pitch)t pewritcr.) <br /> •D=U , `* 71; ..Page lof 3.Emergency Response Phone 14.—M3n-K01'NaaIr1j NumlW Clive <br /> ,q i,,GenerajorlDmumher rp: <br /> UNIFORM HAZARD OAQ 0 8 4 7 27 <br /> WASTEMANTEST <br /> Gene Address(I diforent than malting address) <br /> e t es 4am and�majlinp Adds <br /> GenermpWo Phong: 1 24 C� <br /> hi U.S.EPA ID Number <br /> Pflq� GO m -�7 a <br /> , MT% <br /> � L %Vill, <br /> 1,13.EPA 10 Number <br /> 7.Transporter 2 Company Naft <br /> �1 u.5.EPA ID Number <br /> sine and Site Address SA <br /> 6 oeigriated Facility N <br /> 6011"'0 STH STREET <br /> 5ACRAMEP110 <br /> ±adlil Phone' 10.Containers 11.Total 12.Unit 13,Waste Codes <br /> 9,: 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class.ID Number, QugniAy WLNot <br /> HM and Packing Group(if any)) No. Type <br /> TF1 <br /> )TE Ir <br /> DOW -n-—1H —Du-�q <br /> -1341, .1 ( `11 t <br /> 0 1�1 �. �i . I T <br /> i�0361 N)-9,D04'0) <br /> j-�AP-477-2-Fzi 7 <br /> tax=7111 <br /> 4. <br /> Lj V <br /> Spa'81 Handling If Ban <br /> -ED �WBSEQU <br /> j'f',j V�J^j VZ��,o T6 RgTAIN <br /> pteft of risignment are(tfly and accuMteiY described above by the proper shipping name,Ord ara da"ified,packa6ed, <br /> 15, rENERAT0R)S[0Ff`1i�R0W5CERTtFJG oN; Thereby declare that the ou ta mgwtal rogVla5oqS,ff expoit shipment and I am the Primary <br /> marked and labeledloscarded,BW 2fe in all respedts in proper condition for jranEpori a0comM to applicable riternatonalIrid national gmr <br /> Exporter,I certify that the contents of this consignment mriforrh to the terms d the 04ched EpPAckA0vAedgn)0nt of Consent. <br /> statement identified in 40 CFR 262.27(a)(if I am a lat9a quantity generator)or(b)(if I am.Wsryol quan�ly generator)is True.I cer*that the wa5te rnhimialion state f. I, Day Year <br /> .. <br /> $ipnalure ,'-rs P1r1Pt01jfrr))*d Name, <br /> e <br /> Gqnergice, <br /> ia.i—ntermnationsl shipments Export from U.S. Pon of enlrylwak <br /> 0 import to U.S. Date leaving U.S.; <br /> RE Transporter signature(for exports only): <br /> 17.TranVoft(AckrLowk-dgmentof Rmiptof Malefrals M, Day Year <br /> Day <br /> Y <br /> 16 <br /> TrantWer i Pfin[Offyped ama't <br /> 7-T <br /> i 1-0 5�� - %-V , ml!onth Day year <br /> Trenspoler 2 prinledl ped Name <br /> 18.Discrepancy <br /> 18a.Disqepany Indication Spars 00vantity -Ype Residue ❑Parlial Rejection Full Ra{lllnl <br /> Manifest Reference Nurnj)er U.S.EPA ID Number <br /> I 9b Ntamale Facliity(or Generator) <br /> Facility's Phone Month Day Year <br /> l8c..signahim ofAilemaLe Facility(or Genemlor) <br /> 19,Hazardous Waste-"0 Wnagcmenl Method Codes(L.a.,Odes for hazardous waste Vestment.disposal,and rpcyaing syslerns) <br /> A. <br /> 2. 3 <br /> 20,Designated FaciRYJDwnOt Or operMof:Certification of receipt Of hazardous materialSe-vered by the manifest excep as noted n Item 182,o <br /> S lurb, <br /> X, <br /> 899-3 L70/110d 06Z-J, TZ:Z1 01 ,-81-10 <br />