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_ , Farm Approved,OMS Na;2454-0 <br /> 039 <br /> Nwrif r AP <br /> Please.pnnt or type.(Farm designed for use on elite(1�1 pitch)"type a.). <br /> UNIFORM HAZARDOUS. 1.Generator 1D Number 2.Page.1 of 3.Emergency Response Phone A.Mantt'est Trracking Number <br /> WASTE MANIFEST CAD 8 8 2 5 0 8 2 5 1" - t39•� -5807 1 .000250268 'JJK <br /> 1 <br /> 5.Generators Name and Mailing Address .. - Generator's Site Address(if different than mailing address). . <br /> Ur,Iltled Western G-Ocers U.W.G. _ <br /> Attn: Pat Gdkor N,5200 Stleita Street 1990 PICCON Rd. <br /> Conrrrerc CA 9004£3 Stockton CA 95215 i <br /> Generators Phone:. <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Hoa MatTrans,.inc. C A J. 0 8-'0 0' 1:. 2 :8 'A 0 <br /> 7,Transporter. 2 Company NameNumber:-_ <br /> - N U.S.EPA IA <br /> 8.Designated Facility Name and Site Address, U.S.EPA ii3'Number. I <br /> Stet wi;Water Tedl 10100 s COrp. <br /> 5375 South$Oyie AVG. <br /> VW_nM CA 90058 <br /> Facilitys.Phone: gog r; <br /> ga ' 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers :11.Total ' 12:Unit Waste Codes, I. <br /> HM and Packing Group(if any}) No. Type Quantity .:'..M,Nol: <br /> 13 <br /> t -RCRA.Hazardous Waste Solid, <br /> DM P <br /> W 2 <br /> LU <br /> 4, yl} <br /> 34 Special Handling Instructions acrd Additional Information f f <br /> y F <br /> Ski 1) d"�e���iailfa t/Lak�so bent-k�rotzle #AP1683B4 �i Gloves & Goggles <br /> 15. GENERATQR'SlQFFEROR'5CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping hame;and are ctassrfied paciiaged <br /> marked and labeled/placarded,and are in all respects fn proper condition for transport according to applicable international and national govemmental regulations.If exporCshipment and I am the Pnmary <br /> Exporter,I certify that the consents of this oonsfgnment nonfarm to the terms of the attached EPAAcknowledgmeni of Consent. l <br /> I certify that the waste minimization"statement identified in 40 CFR 282.27(a)(if I am a large quantity generator)&(b)(KI am a small quantity generator)is true + - <br /> Generator51Offerors PrinladlTyped Name Stgnaturey / -All <br /> Month Day; Year" } <br /> El <br /> 16.International Shipments Import to U.S. E=—I Export from U S Pori of entrylexit <br /> 7ranspbrter signature"(for exports only): Date leaving U.5:: f <br /> 17.Transporter,4cknowledgment of Receipt of MaterialsLLI <br /> t <br /> Transporter 1 Print [Typed Name .'Signature. Month Day r. Year 1 <br /> Z j6rispi5r1br7 Frdhfe&Ty*Name ^igfia ondh Day Year <br /> 18.Discrepancy 1 <br /> 180.Discrepancy Indication Space , F-1.Quantity E]Type Residue Rejection 0 i <br /> ❑ 0 Partial Re" tion", Full Re ecticn <br /> Manifest Referehca Number: ' <br /> i <br /> 18b.Alternate Facility(or Generator) U_S.EPA ID Number ) <br /> I <br /> ra+. Facility's Phone: " <br /> LU 18c.Signature of Ntemate Facility(or Generator) .' Month.; "Day' Year, <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems)" <br /> LU <br /> 1 12. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in item 118a i <br /> Printed/Typed Name Signature Month ,Day, "'Year <br /> =EPA Ferrri 8706 (Rev.3-0 ) Previous editions are obsolete: . DESIGNATED FACILITY TO GENERATOR <br />