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Please print or type.(Form designed for use on elite(12-pitch)typewriter.)
<br /> UMIFr)RPJI FIA71\P,DOIIS Form Approved.OMB No.2050-0039
<br /> 1.Generalur ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifo t Tracking Number
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<br /> NLA T C MANIFEST CA098145'x'2 r�
<br /> 5,Generator's Name and Mailing Address.• Generator's Site Address(If different than mailing address)
<br /> •3hh;F fiNdl_iN.,A`(
<br /> 7A0 FAST t A,RNEGIE DRIVE -, -
<br /> SAN nEriaa�,,<ritr^l��..CAp�acr8 u.�,.�,
<br /> ��Il.!4l:Tf Irl,1,/'. _*552 b U.{. "
<br /> IGeneralor's Phone i]w•",r'C--Si!S3
<br /> G.Transporter 1 Company Name U.S.EPA ID Number
<br /> t NVIRONIOEP-JITAL LOr_I•3i1GWNG I CAR00017':1:;E0
<br /> 7.Transporter 2 Company Name U.S.EPA ID Number
<br /> 8.Designated Facility Name and SileAddress FILfEr RECY03L}I^NG ;1 R1;h'E�;,IJNJC U.S.EPA ID Number
<br /> 180 WEST N,10111TE A'•IENUE
<br /> SLOOf-MIlIGTON,CA 92316.1_}.S.G,
<br /> Facility's Phone: —
<br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13.Waste Codes
<br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol.
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<br /> 2 2.
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<br /> 4.
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<br /> 14.Special Handling Instructions and Additional Information
<br /> 3rj•11 SCIIUALLA_T(ROG-KI,LEAD 33 STLC,TFCPH --300 PPifi PRC1F1LErJiA[ill, QDL- Itt}VOJC-,�t/�t�ZV Q-,,o
<br /> PLEASE V17=A.i=: AP PROPRI.ATE PR.OTECTftiE`F71 IPIviENT. /moo. � '40 k,/
<br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATIOM:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shiPpitfg 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 governmentat regulations.If export shipment and I am the Primary t
<br /> Exporter,I cerlify Thal Ilia contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent.
<br /> I certily that the waste minimizalion statement Identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true.
<br /> Generators/Offeror's Printedrilyped Name � �r'= �r� j`� f :�'Signature ,�^ Month Day Year
<br /> .r 16.International Shipments
<br /> ❑Import to U S. ❑Fxporl from U.S. Port of entry/exit:
<br /> Transporter signature(for exports only): Dale leaving U.S.:
<br /> 17.Transporter Acknowledgment of Receipt of Materials _
<br /> Transporter 1 Prinledrryped Name Signalure Month Day Year
<br /> IL ,
<br /> 010
<br /> TranspoRer 2 Printed rTyped Na ne —�nA ure Month Day Year
<br /> A 18.Discrepancy
<br /> 18a.Discrepancy Indication Space ❑ Quantity ❑TypeI
<br /> �— ❑Residua ❑Partial Reaction El Full Rejection
<br /> _ Manliest Reference Number:_
<br /> L t 18b__Alternate Facility(or Generator) J U.S.EPA In Number
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<br /> e;.: Facility's Phone: _ I_-
<br /> 0UJ 18c.Signalure olAlternale Facility(or Generator) Month I Day I 1'car
<br /> u� 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems)
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<br /> 20.Designated Facility Owner or Operator cerlilicalion of receipt of hazardous materials covered by the manifest except as noted In Item 18a
<br /> Ell eIpcd Name �.__ �— v — Slanalure r — fYlpnlh Da Yeas
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<br /> THE CAT SCALF GUARANT7E
<br /> I'he CAT Scale Company guarantees that our scales will give an accurate weight.What makes
<br /> us different from other scale companies is that we back up our guarantee with cash
<br /> TICKET NUMBER I011
<br /> ® "WEIGH WHAT WE SAY OR WE PAY" S
<br /> If you get an overweight fine from the state AFTER one of our CAT Scales showed a legal weight,we will ,
<br /> immediately check our scale and we will:
<br /> (1) Reimburse you for the cost of the overweight fine if our scale is wrong,OR
<br /> (2) A representative of CAT Scale Company will appear in court WITH_the driver as an expert witness if we
<br /> _QA _ I LZ believe our scale was correct.
<br /> IF YOU SHOULD GET AN OVERWEIGHT FINE,YOU SHOULD DO THE FOLLOWING TO GET THE PROBLEM RESOLVED:
<br /> )rsER IrIED 1) Post bond and request a court date.
<br /> AUTOMATED
<br /> 2) Gall CAT Scale Company direct 24 hours a day at 1-877-CAT-SCALE(Toll Free).
<br /> 3) IMMEDIATELY send a copy of the citation,CAT Scale ticket,your name,company,address,and phone number to
<br /> RUCK CAT Scale Company Attn:Guarantee Department. .
<br /> S'`'''ALEThe four weights shown below are separate weights. The TOTAL WEIGHT was weighed on a full
<br /> CAT SCALE COMPANY length platform scale. AXLE WEIGHTS CAN NOT BE CERTIFIED and are NOT LEGAL FOR TRADE,
<br /> RO.BOX 630 however,CAT SCALE COMPANY GUARANTEES THESE WEIGHTS TO BE CORRECT.
<br /> WALCOTT,,IA 52773
<br /> (563)284-6263 STEER AXLE
<br /> www.catscale.COM DATE: 2. z.
<br /> DRIVE AXLE
<br /> SCALE
<br /> LOCATION: TRAILER AXLE .x ��jl7ir
<br /> '.L•...i} ..
<br /> 9 S EAST VA(_.I-EY BL_':'41TOTAL AXLE
<br /> WARNING
<br /> THIS �FORM IS NOT A CALIFORNIA WEIGHMASTER CERTIFICATE AND IS NOT
<br /> LEGAL F 0 A D E IN THE STATEOF ••
<br /> COMMODITY-OR ARTICLE.WEIGHED
<br /> ----
<br /> COMPANY ^- rr rtr Y" k Ttsfe- TRACTOR# °�i ':'TRAILER#
<br /> FULL WEIGH
<br /> FEE WEIGHER SIGNATURE TICKET#
<br /> (IF REWEIGH)
<br /> , DYE,.r.. rl��.i:It t�"i
<br /> lTO1fIGR COPY DRIVER IN TRUCK UNLESS CHECKED HERE: VCAT
<br /> ScaIe�CA3039et/I1
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