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_-JAN U 2 2014 <br /> Fri" <br /> —Generator,Mall a copy to: DTSC P.O.Box 400 Sacramento,Ca.96812-0400 within 30 days.*" <br /> please rent a type. rwrrn deal ned toraso on elite 12-pitch)ty"Otar:} y <br /> M.Fm TAL <br /> UNIFORM HAZARDOUS 1 r Ni ,l ,,ra Z Page 1 of 3,Emergency Response Phone 4,Ment esttTracking N <br /> WASTE iNANIFESTommi- <br /> b-424-9300 008643828 JJ K <br /> 6.Gertraratora Name and Malang AddressV'4- "T,"� n e 5I eAddross{lt df(orsnt Ut a mel9ng addrossJ <br /> Qd s Phone., +x ��"i�' ,� <br /> ralor' P <br /> r 1 CamparayName U,S.FA DWnbor <br /> Tra <br /> r reen Environmental Services CAD982x�1$282 <br /> 7.Trattapatkx 2 Canpanyt Name U.S.EPA 1D Nurnber <br /> 6.Designated rndfliy Nero and Sre Aftm U.S.FWD Number <br /> Evergreen 011,Inc, CAD980$87418 <br /> 6880 Smith Ave. <br /> Fadti11 sPhone: Newark,Ca.94680 <br /> 4400 <br /> ga 9b,LIA.DOT Desalptiaa Qnduding Proper Shipping Name.Hazard Class,ID Number, 10,Containers 11.Total 12,Unit 13.Waste Codes <br /> HM and Packing Group{H any)} s p y No. Type 4uangly WtAVoI. <br /> if <br /> od <br /> lu <br /> r <br /> 3. <br /> k. <br /> 1 l lletdrtng nst nsan in mtatafn <br /> 15. SrENERATOR'SIOFFEROR'S C UtTIFIGATION;I hereby deeate tint the contents of this conalgranapt are fitly and acournkrMy described above by proper s fWAg name,and are classier!,packaged, <br /> marked and labeled/placarded,and are In all respects In proper condition for transport aocofding to appficalde lonatand national governmental reguiaUans.If export shipment and I am the Primary <br /> Exporter,I cetlfy that the contents of this consignment oanform to the terms of the attached EPAAdmowledgmer Consea , <br /> I certify that the waste minimWon statement Identified In 40 CFR 262.27(a)of I am a large quantity gaperaw) )(9I em a amore tm)is true, <br /> Gan stem'sXypod Name Sign Martin pay YJoer <br /> -1 <br /> 16.InuSroat mal$Wpm* �Import is U.S. l_.►Export from Port of enlrylexlt: <br /> Tranaptalrx sfgrurhae{fpr exports onlY}; (]ata Mravarg U,S: <br /> 17.Transporter Acknowledgment of Recelptof Materials <br /> Transport) PdntodfTyped Name <br /> Month C��y r <br /> ran) c Name SignaW traria Day Yam <br /> 16,Dkacmpancy <br /> r-� LJ Parilal Re ecuon ❑Full ReJectlon <br /> 18a,Dlsaepancy Indication Space p Qusngty l �'fype �Rssidue J <br /> fAarlfest ReWrcnca Nu <br /> iBtA,Ntsant+ta Fnciily{ar(3enerator) <br /> U.S.EPAI Ntaxther <br /> W FaWsPhone: Month Da0y year <br /> 1Ss.Slgpattse o tarraelo acNhy <br /> 19.Hazardous Waste Roped Managamard Mallwd Codes(.a„codes for hazardous waste traatmern,disposal,and raryc syslams) <br /> / 3.2. <br /> a. <br /> Deslga"Fadllty Owner or Operator:Cerdficatlon of rept of hazardous materielsf]W <br /> lta iia <br /> 4s .type ams Monthray Yaar <br /> 7. 0=22(Ray.305} Pfwtousodl sareohsolete, FACILITY TO DESTINAT[UN STATE(IF REQUIRED) <br />