Laserfiche WebLink
10 0 <br /> r\T C CC(-i C Q rY 1 1" <br /> U YJL VVC +JW V1 Lt <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.205MO39 <br /> UNIFORM HAZARDOUS 11,Generator ID Number 2,Page 1 of 3.Emergency Response Phone 4.Manliest Tracking Number <br /> WASTE MANIFEST DAL 0 0 0 010 9 8`3 ! (209)9440909 001988472 JJ K <br /> 5.GenerNor pdFdarLrn &R-r0oa G IDerarcr E (i1STOCKTON ling address) <br /> 1137 S.SIOMon Street 1137 S. StoMon Sire <br /> SIOCILM",CA 96206 SIOCktefl,CA 96206 <br /> Generator s Phone 9 WM�t Mtn 1Z%SWIZIM OWtKt Ydt <br /> fi. EPA ID Number <br /> TranffW&W*ftMMTAL TECHNOLOGIES CORPORATION/AES (M)708-4246 UC A D 0 0 9 4 5 2 8 5 7 <br /> 7.Transporter 2 Company Name S$h�e�A,q�� U.S.EPA ID Number <br /> fi.DeWMAIwi hfE► ArTECHNOLOGIES CORPORATIONWAES U C A 0 0 0 9 4 5 2 6 S 7 <br /> 2081 Bay Road <br /> POO ARO,CA 91303 <br /> Facili s Phone: <br /> ga. gb.U.S.DDT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.TOW 12,Unit 13-Waste Codes <br /> HM and Pecking Group(if any)) No. Type Quantity WWol. <br /> 1.OTHER REGULATED SUBSTANCES.LIQUID.N.O.S.9.NAM,111 343 <br /> p (ETHYLENE GLYCOL) 277 <br /> / �] <br /> a 2. <br /> W <br /> 3. <br /> 4. <br /> d4.S1:F 1I�nLLilllstl-`JCd CfR �IllSa <br /> ry�.1 0500 <br /> V",72041487 <br /> 15. GENERATOR'S10FFEROR'S CERTIFICATION: I hereby dedere that the contents of this consignment are fully and accurately described above by the proper shipping name,and ara classified.packaged, <br /> marked and Iabeledfplacarded,and are in all respects In proper condition for transport according to applicable International and national governmental regulators.Ii export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terns of the attached EPA Acknowledgment of Consent <br /> I certify that the waste minimization statement identified In 40 CFR 292,27(a)(II am a large quantity generator)or(b)(if I am a small quantity generator)Is true, <br /> GeneratorsfOfferoes Printed/Typed Name Signature Month Day Ye <br /> )lo " 5,130 10 <br /> .J1 16.Irtemational Shipments <br /> F ❑Import to U.S. ❑Export from U.S. Port of enbylexit <br /> z Transporter sdgnature(far exports only}: Date leaving U.S.: <br /> W 17.TransporterAduwwledgment of Receipt of Materials <br /> Trans rter 1 Prinriped Name Si lu Month Day Y r <br /> 0 <br /> co <br /> Q Transporter 2 Printed(Typed Name g re Month Day Year <br /> rX <br /> t- <br /> 18.Discrepancy <br /> 1Ea.Discrepancy Indication Space ❑ auantity ❑Type ❑Residue <br /> ❑Partial Re)action Ful R"eteeti <br /> on <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generatorl U.S.FPA ID Number <br /> J - <br /> U <br /> Facility's Phone: <br /> W 18rSignatureodAllemateFacility(orGenerator) Month Day Year <br /> Q <br /> z <br /> H19.Hazardous Waste Report Management MebW Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2. 3. 4. <br /> 20.Designated Facility Owner or Operamr.Certification of receipt of hazardous matersats covered by the manifest except as now in laa <br /> Printed(Typed Name Signature Month Day Year <br /> aA <br /> 3a <br /> EPAFortn 13740 22(Rev.3-05} PreviOusedi60 are obsolete DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 10142.0151 <br />