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• DTSC. 03G01 . 1536 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 0l 3.Emergenry Response Phone 4.ManNeat Tracking Number <br /> WASTE MANIFEST CARD 0 0 2 2 5 5 5 7 .1 NRC 510 740 1390 014378811 JJ K <br /> 5.Generators Name and Mailing Address Generators Site Pddress til diflerenl Nan mailing address) <br /> YRC FREIGHT <br /> 1535 E PESCADERO AVE <br /> TRACY CA 95304 <br /> Generators Phone: 2 0 9 8 3 3 - 1 <br /> 6 Transporter 1 Company Name U.S.EPA ID Number <br /> NRC ENVIRONMENTAL SERVICES INC. C A R 0 0 0 0 3 0 1 1 4 <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> fr ' •C . 'G <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Crosby&Overton,Inc. <br /> 1830 W. 17th Street <br /> Long Beach CA 90813 Q <br /> Facitit Is Phone: q <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Tocol 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WtNol. II <br /> q: RQ UN1719.4114STE CAUSTIC ALKALI LIQUIDS,N.O.S.,8,)I, I 122 0007 <br /> (SO011 iM HYDRO`All BASED LASPAOIS) O� 3 <br /> 2, NON-RCRA HAZARDOUS WASTE,SOLID,(ABSORBANT WTH 331 <br /> LATEX PAINT) 3 F' L <br /> 3. NON-RCRA HAZARDOUS VASTE,LIQUID,(OIL) 1 DYh .S C7 (—A221 <br /> a. NON-RCRA HAZARDOUS WASTE,SOLID,(CONTAINS CITRIC 141 <br /> ACID) S O( D� P <br /> 14,Special Handling Instructions and Admtonal Information <br /> WEAR APPROPRIATE PER301NAL PROTECTIVEEQUIPMENT JOB# 101559 <br /> PROFILE# 951: 67855 952: 51599 953: 58380 954: 57425 <br /> .. 15. GENERATOR'S'OFFEROR'S CERTIFICATION: IMreby tledara Nat Ne contents of this consignment are fully and accurately described above by the proper shipping name,and are dassli,packag <br /> marked and Iabeledtplacarded,and are in all respects in proper condition for transport according to applicable Internatonal and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I Partly,that the contents of this consignment contour to the lentis of the attached EPA Acknowledgment of Consent, <br /> I cenify that the waste minimization statement identified in 40 CFR 262.27(a)(d I am a large quantity generator)or(b)(HI am a small quandy generator)is We. <br /> n�e7r'at'o'rslOtterors Firms typed Name Sig Moo Day Year <br /> Ge <br /> 7 i6.IMerra6onal Shipments Ll Ifni to'JS ❑Export from U.S. Port of entry/exiC <br /> M Transporter signature(fur exports only): Date leaving U.S.: <br /> K 17.Transporter AcknoMedgmentof Receipt of Materials <br /> ya Monty Day Vear <br /> C Transporter 1 Pdnted/Typed Name Signafure <br /> aCIS C. ei Monty Day Y29 ( <br /> z Transporter 2 Pnntai d Name SigSignatureear <br /> Q <br /> Ci_ I <br /> � C—f7J <br /> 18.Discreparrcy <br /> 18a.Discrepancy IntlioSin Space ❑ Quantity Type ❑Restppue ❑PaNal Rejection ❑Full Rejection <br /> Orb.3 COSI\ SI )x b1Q \ra p 1kxz &zz.�exesTE SDl`cQ — °� <br /> 0 Manifest Reference Number. <br /> U.S.EPA ID Number <br /> 18b.Allemata Faciity(or Generator) <br /> J <br /> U <br /> ua. Facility's Phone: MmN Day Year <br /> W 18c.Signature AAudi Facility(or Generator) <br /> Q <br /> z <br /> � 19.HauNous Waste Report Management Method Codes pe.codes tort hazardous waste tmaMent diywsal,and i systems) <br /> N 3 4 <br /> 2. l Il <br /> t ` <br /> 510esign&W Tity PurerorOperabrCerci" so 1re tal rials covered M Ne manifest except as rMad' m 18aMonty Sigrr turaEPAe 3-05) viouseditionsareobsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br /> 12252.0239 <br />