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DEC 1 12 ""'(iii <br />Please Drint or tme. tFnrin dAinnAd r—t— nn ata. rf j—ai hi hrn <br />?-(emus activons are onsvela. [ E TED FACILITY -10 OVSTINA7110N s T>t rp nromm',n) <br />UNIFORM HAZARDOUS 1, Generator [0 Number2. Page tel 13. Enw9oncy ResponsePhone <br />WASTE MANIFEST C A R 0 0 0 0 0 1 7 a I-, 1110P <br />-74390 <br />164 <br />141(9 MM,85 JJK <br />S. Genvator's Namo and kfaillng Arldress Att DUFFYEXON Generator's Site Addrw3 (4 different than maAV address) <br />UPRR <br />UPRR <br />i=i FOOTHILLBLVO 11000 E ROTH RD <br />ROSEVILLE CA 05747RE :NCH CAMP CA 95231 <br />.Generator's Phone: 9 5 1 1 4 [ <br />-3 <br />0. Transporter I Gorap, N <br />ENVIRONMENTAL <br />U.S. EPA 10 NumberNRC <br />SERVICES INC. <br />A R 0 0 0 <br />0 3 0 1 1 4 <br />1, Tncf 2 Company Name <br />U.S. EPA 10 Nuelter <br />— <br />Zr-z- <br />�1- <br />IiEf 2h - <br />,, <br />ad Site "tesg <br />oe MeWayl—i-Nanagement-Ki-IFU.S. <br />ENA i4 Nurnbor <br />3525 f Old Skyline Rd <br />KettlernanHills CA 93239 <br />1F3cwsphMq;d69 380-0101 <br />A T 0 0 0 <br />6 4 0 1 1 1 <br />93, <br />A U.S. DOT Description fvtckeN Proper $Npp[n Name, Hazaid Class, tO Nkimbar, <br />to. Contai, are <br />11 Total <br />12, Unit <br />Fri <br />awPac"Groupvany)) <br />I Ovantity <br />%IAM <br />M Waste Codes <br />Type <br />NCN-RCRA HAZARDOUS WASTE SOLID (DEBRIS WTH <br />1 1 <br />o <br />CHLORINE- DIOXIDE CONTAINING DIOCIDE) <br />DF <br />090 <br />181 <br />F, <br />14ON-RCRA HAZARDOUS WASTE Soup (EMPTY DRUM LAST <br />CONTAINED CHLORINE DIOXIDE CONTAINING BIOCIDE) <br />or <br />12 <br />3.P <br />4. <br />14,ral HarAW%Wxbons aridAMitlonal Information <br />U E PRO <br />R PERSONAL PROTECTIVE EQUIPMENT <br />JOB/90#62006 PROrTLE # I]CA604679 21CA604618 <br />NRC ENVIRONMENTAL 3ERVICZ3 INC. 1605 FERRY PT ALAMEDA CA -94501 <br />15, GENERATOWSIOFFEROR'S CERTIFICAtift I wabydedats that the 0ontents of INS wnslQMoAt ala My and aomratelydescr-bed above Dy ate proper shipping name, and ata dassiud, packaged, <br />marked and and aro in at respects In proper oonditton W transport aa"&q to AW=b?a interna anal and nadwl gowmmental tviations. tf export shipment and I am iho Primary <br />Exporter, I corrify that rtta mnl�tis of this rnrtsgnmant confam b the terms ai the adacAad EPA Arlvsaviadgment of Gc�nsant. <br />I wrlify M ft waste m"minW slatemord Wentilled In 40 CFR 26227(a) fit I am a targa quantity qataratoor (b) III am a &maff qMty generate) is we. <br />Soature <br />Month Day Year <br />10 <br />-j <br />F <br />16. international Shornerits <br />0 t"4, .U.S. Eqt f. U.S. ped of on4y"ea4 <br />Truspader signake (for expoaq My): Date leaving UA: <br />U. TimWe(AtkoWedoment of Racelpt olFfalarWa <br />Tlanspwar I Pmle(VTypad Name S"hwe <br />Month 04 Yea? <br />0-X414CA <br />--A <br />Transporter 2 Pffit6diT)p0d N-' Signalue <br />i0. DisaepanCy <br />klorth Day year <br />ttla. Dlsaepancy lr4callm Space [-] Uuarwy 0 fyp. L1 Resides <br />❑ ParWl Rej.0. <br />N4 R,jac'kn <br />Ro'eto" Number. <br />18b. Alternate Faciaty {orGenerator}Marif"t <br />U.S.EPA II)Number <br />to <br />FacRity's Phone: <br />@ <br />f&a. *wture olmimato Faamtj (or oavaratw) <br />Month Day Year <br />19. ilazaidoos Wasla NIM Management Method Oade$ CC463 for haf&d0L'4 West$ trO&L-reflk djSposm, AM re1*tjn1g systems) <br />C1 <br />u <br />Faoft 3poratol: Cer0c*Nn o(rmlotothuardous frate6alsove(ed by the ma�W�isWod In Item IU <br />r�nte&jp I <br />rp`20 <br />"T VSg re <br />.res Defy ;r <br />?-(emus activons are onsvela. [ E TED FACILITY -10 OVSTINA7110N s T>t rp nromm',n) <br />