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DECEIVED-- - <br /> Please print or type.(Form designed for use on elite(12•pilch)lypewdler.) Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number ..age 1 of <br /> A .Emergency Response Phone 4.Manifest Tracking Number <br /> STE MANIFEST 013435262 J J K <br /> eneralms Name and MailingAddmss - raturs Site Address Of different than mailing address) <br /> PACIFIC SrXltr, <br /> T 'F-:>i IRRIGA(ION HFA ?Nnr-C` T4ACM . <br /> 8_'�S.JAGr4Tt7td FD. _ - <br /> gmcl<TramLcA 35.2E <br /> Generators Phone: t+`3-46O-04SR U.S.EPAID Number <br /> 6.Transporter i Company.Name <br /> G'LEi O2 US:{.0Yrr9.,{nc. <br /> 7.Transporter 2 Company Name U.S.EPAIDNumber <br /> B.Detgrtlg�.�.acl't.Njmf01&4 flsp ss U.S.EPAID Numbe,.,;,,;,.r <br /> --.100 lo,`171;SipaM <br /> Facility's Phone: <TRt''v":7•c�2:f <br /> ga, fib.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Tatal 12.Unit 13.Waste Codes <br /> HM and Packing Group Off any)) No. Type Quantity WINol. <br /> 1' 'rlh!1£5!3 ;RrF:`?T'f'P:.y�:ilv1;4(.•?i1`.IdCtu10 r;. (ACE?Onr c 3 P+31i i1[f G I Ckk]1. <br /> Z 2 <br /> W <br /> t, <br /> 3. <br /> 4. <br /> 1 :Special Handling Instructions and Additional Information <br /> - F Rlr t12(1 'g-Pw SIE PVC pips ptiriir'.i <br /> 15. GENERATOR'S[OFFEROWS 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 labeled/placarded,and are in all respects in propercendifidWtransport according to applicable international and national governments]regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> rl cerdly that the waste minimization statement identified In 40 CFR 262.27(a)(if l am a large quantity generator)or Ohl(if I am a small quantity generator)is We. - <br /> rr'- <br /> Generalorsl0ffeiord PnntedRSignature Month Day Year <br /> yped Name r, g <br /> w <br /> r. 16.lntemational Shipments, <br /> F - Import to U.S. ❑Exportfrom U.S. Pod of entry/exiC <br /> g Transporter signature(for exports only): Dale leaving U.S.: <br /> CC W 17.Transporter Acknowledgment of Receipt of Materials ' - Month Da Year <br /> K Transporter 1 PdntgFyperd Name f Signature ..'!,' �} Y <br /> a �,v..'s 1 t-•. f` r.r�. i .4,.6. r I ce <br /> Z Transporter 2 Printed/Typed Name l Signature Month Day Yeaz. <br /> Q , <br /> t- <br /> 18.Discrepancy <br /> T 18a.Discrepancy Indication Space ❑ Quantity ❑Type El Residue ❑Padial Refection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Ntemate Facility(or Generator) U.S.EPAID Number <br /> a Facilil)•s Phone: <br /> w 18c.Signalure of Atemate Facility(or Generator) - Month Day Year <br /> Q <br /> Z <br /> . azaraous Waste Report Management Method Codes(i,e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of mceiplof hazardous materials covered by he manifest except as noted in Ilem I fe <br /> Pdnted/Typed Name Signature Month Day Year <br />