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Please pnnPdr type. (Form designed for use on elite (12 p • er.).' Form Approved OMB No 2050-0039 crrn rutin oruu-,4 krcev. u-ua) rrewaus editions are oosoie[e. DESIGNATED FACILITY TO GENERATOR UNIFOR 11. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 14. Manifest Tracking Number WA NIP@ST CADOOM3592 1 408-768-4966 .. 0.0 94 76 9 3 2 . JJ K . 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) ECS Rebning 705 Reed St.; Santa Clara, CA 95050, Genemlors Phone: 400 968 4386 B. Trans Company Name .-- - .S. EPA ID Number \fiar-T of<n�'��) 7. Transpoder 2 Company Name U.S. EPA ID Number i 8. Designated Facility Name and She Address ID Number AL HEAL7Wf EPA Oftnersus LLC _ DEPARTME�IT fXR000000034 1Cn6 Ta}as OrtvQ Fatuity's Pho(taR®(ir TX 75160 972.524-1075 go. HM 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class ID Number, and Packing Group (if any)) 10. Containers - 11. Total 1 12. Unit 13. Waste Codes No. .Type _.. .......... .. _. _. _.. Quantity WtNol. 1 Plan-RCRA Hazardous Wasts SoNd Lead) ( ExEM T W 2. P On-RCRA Hazardous Mste Sopd (Lead) EJ(EM T 3. NQn-Kk;ftA t`WZaJ`UCUr VVaGle 60WJ (Leatl) 47 DM S,;t70 P 4. No'N aCy2A MA LAjZDOU5 L✓q e,.yra%ca9clLetid)eAe g cr 2P7 P 14. Special HandlingInstructionsenInformation Weer gloves, gggles; DOT E margiiirisy FensaG4karook*t71 'z h/14 -DOS f 21 UAScrAeq ?"P 24 Hour transl"Don ameryGncy M11 ECS Emar jency Cap 408-7813.4958. 3. A t r Fi,o-'i2 r5 N, A e r5 This matortal restrlctGd from land dtsl0=1 cCCording to 40 CFR 268.40 etldfor 22 CCR 8ir'MAD I.S. GENERATOR'SIOFFFEROR'S CERTIFICATION: I hereby deeclare that the contents this consignment are fully and accurately described above by the proper shipping name, a'rd are daSdBed, packaged, marked and labeled/placarded, and are io all respects in m er condition for trzns'n according loapplicable international and national ovemmental regulation If export shipment and l am Ne Primary' Expoder, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledginenl of Consent. .' Iceddy that the waste minimizalon statement identified in40 CFR 262.27(a)(if l am a_ largequankygeneral&)oi (b)(iflimasma�uanfi genera or is true. Generatoes/Offemes Prinledrryped Name Signature i� Day Year Mo � � ��_qb-� /71,/,1- .. _3 F- 18. International Shipments ❑Import to U.S. �Expotl from U.S. Port of envy/exit: Z _Transporter signature for exports ony:. Dale leaving U.S.: _ Lit 17. Transporter Acknowledgment of Receipto(Materials' t"- OSignature Trans Berl PdntedR ed Name Month Day Year 4 Transporter 2Printed/Typed Name Signature Month Day Year K - t - 111. Discrepancy 1 a8a. Discrepancy Indication Space ❑ puerility ❑ Type y ❑Residue ❑ Penial Rejection ❑ Full Rejectan Manifest Reference Number. - 18b. Alternate Facility(or Generator) U.S. EPA NO Number U w18c. Faciltyrs Phone; - Signature efAltemate Facility(or Generator ) Month Day - Year F- Q N,19. Hazardous Waste Repod$lanagemenl Method Codes (i.e codes for haiardduswaste treatment disposal, and reading s�sfems) .-_. p T.. 2. 3. '4. ... 20. Designated Facility Owner or Operator: Ceffi6tion of`recelyt of hazardous materials covered by the manifest except_ as noted in Item 181) �., ��- Print ypedNama Sgnalure ;Monty �• Day Year �-/ �2pyvc /1 da 0,1415 C— 11779 _PLI09210C -5_ �/ % L - crrn rutin oruu-,4 krcev. u-ua) rrewaus editions are oosoie[e. DESIGNATED FACILITY TO GENERATOR