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• . ORDER tl 335631 <br /> Please print or type. (Form designed for use on ellte(12-pkch)"writer.) Fpm,approved.oma No.2050-0039 - <br /> UNIFORM HAZARDOUS 21.Uenerators US EPA IU No. Manifest Document Na 22 Page Information in the shaded <br /> WASTE MANIFEST areas is not reggfred by Federal <br /> t (Continuation Sheet) C A D 9 8 1 3 9 6 0 2 2 of law. - <br /> 23.Generators Nama - Doeam tender <br /> GENERAL HILLS . 5'933 <br /> ATTN: WADE BROUGHTON <br /> BOR 3002 ; LODI , CA 952411906 VAMP. <br /> 209-334-7090 EMERGENCY CONTACT: BOX 32 <br /> 24.Transporter Company Name ^^�25.US EPA I Number <br /> am <br /> 26.Tra iter Company Name 27,US EPA ID Number <br /> �S Svc, 7 7 r <br /> 28.US DOT Description(Including 29.Containers 30. 31. - <br /> p ( gProper Shipping Name,Hazard Class, and ID Number) Quantity <br /> Unit t1al6 Z i <br /> r No. 7 ouanti WWoI -. <br /> a. WAUrid BUN HURA HAZAHUUUU WA51b L1UU1U ��lasxiu'' <br /> v� <br /> of <br /> 6. (WATER BASED VIDEO TET INK) p F SwF$ a .2P <br /> 001 On 2 NONE <br /> C. <br /> T.IR3d <br /> Got D Poo y5� P NEiNt <br /> E d. (WATER-BASED GLUE) A91 ---- <br /> n �e�3 <br /> M Q . <br /> E OD 8` Z $O NONE <br /> CEA" POl-1 Dju4,s oA PRzls� 00( a `t3- <br /> I M111 <br /> -Iff <br /> h. <br /> ssN a ?T E. <br /> ,$, :".�ra.� `t`s' t �IIsN't Sffr"x r' � el - t.,�•s�LL.f <br /> i <br /> .ed <br /> 32.Special Hand <br /> lin glnstrtddions and Addif nallnfor atlon WEAR APPROPRIATE PROTECTIVE GEAR WHEN HANDLING. <br /> EMERGENCY CONTACT: CHEMTREC: 1-800-424-9300. CALLER MUST IDENTIFY UNIVAR USA AS <br /> SHIPPER. <br /> PLACARDS PROVIDED BY CARRIER/SHIPPER YES/NO DRIVER SIGNATURE <br /> T 33. Transporter 4Acknowledgement of Receipt of Materials Date <br /> a <br /> sN P'_x- ,,e � Signatu L !ton <br /> Day Year <br /> i/ <br /> P _ <br /> 0 34. Transporter_ Acknowledgement of Receipt of Materials Date <br /> R r ITy Na Sign r h Day Yea <br /> E <br /> n <br /> . Discrepancy InclitatIq Spec <br /> f <br /> I <br /> T <br /> Siyfe Cl'18 L41111ILAAMOMMM1,5101 •w1Mis`rma Er FOfm8700-72A(Rev 4881 Aevwusednons ere eCsekre. <br /> ®riri®dernamwea ORIGINAL - RETURN TO GENERATOR <br /> u.abraexw� �, <br />