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515L 'SK SHIP# 217007877 1111111 Blit{II 111111111II NB l if 1111 <br /> 005028631 SKS <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 CAL000226285 2.Paget of 3. ` 8 0 14.6nds�ajkii 31WASTE MANIFEST SKS <br /> S.G�erall,NamE a/Id ldaikng Adders Generators Site Address(d different than mailing address) <br /> onso l is a ' l-witainer Co <br /> 75 W Valpien Rd <br /> Tracy CA 95;x,76--9129 <br /> X09-836- 151 <br /> Generators Phone: <br /> ITSAWrfl�q-nom SYSTEMS, INC. U.S.EPA ID Number TXROOOL481205 <br /> 7.Tan iter 2 Company Name T U.S.EPA ID Number <br /> ) <br /> �'i S0(9_73 <br /> 6.Desgna d Faciity Name and Site Address LEA HARE ARIZONA, j US.EPA ID Number <br /> 1340 W LINCOLN ST I <br /> ¢�Z <br /> 602-258-6155 PHX j AZD049318009 <br /> Facility's Phone <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Ciass,10 Number, 10,Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. NONE NON RCRA I-IAZARDOUS .WASTE SOLIDS, DM P 223 <br /> o (ABSbRBENTS, RAGS, OIL), N/A I.I -- <br /> r-- I i <br /> Z 2. <br /> LU <br /> 3. <br /> 4. I <br /> 14.Special Handling Instructions and Additional Information r <br /> 24 HR EMERGENCY #1-800-468-1760 (SI; / TFI) <br /> AUTH AS "AGENT-FOR" BY GENERATOR TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY <br /> 15. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national govemmental regulations.N export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgawt of Consent. <br /> I certify that the waste minimization statement ideni in 40 CFR 262.27(a)(41 am a large quantity generator)or(b)(if I am a small quantity generator)is We. <br /> Ger ort N ors rinlWyped Sgnayr Month Y� <br /> NU __%k�MC06 <br /> 16 Internai Shiipmenis <br /> �. ❑Import to U.S. Export from U.S. Port of errtrylexil <br /> ? Transporter signature(for exports only). Date leaving U.S.: <br /> w 17.Transporter Ackriowiedgment of Receipt of Matenals <br /> T porter 1 P' ledlT Name Signatu IW­ Month Day Year <br /> O `�3 (S <br /> ,L <br /> M Tran.Voii 2 Prin yped Name SMonth Day Year <br /> Q <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 18b.AJternate Faciiiy,(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL. Facility's Phone: Month Day Year <br /> W 10c.Signature of Alternate Facility(or Generator) <br /> Q <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste treahnent,disposal,and recycling systems) <br /> U 1 #/t// 2 3. <br /> 4. <br /> 1 <br /> 20.Designated Facility Owner or Operates:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name1 5{gSignature MO Day YearJr0e- Ud(fol <br /> EP91- qag�gg .iousedi5onsareobsolete. DESIGNATED FACT ITYTO DESTINATION STATE(IF REQUIRED) <br />