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DEC-11-201- 08:26 TUFF BOY TRAILERS 2E1927-9708E, P.02 <br /> y , <br /> Form Approved.OMB No.2050 <br /> Please print or type.(Form designed for use on elite(12•pitch typewriter, 003,9 <br /> 1 oerator.ID Number 2 Page 7 of 3.Emergency RPSponse Rhone 4.Manifmst Tracking Number ((�� pp <br /> UNIFORM HXZAR�iC,1,111AGdT,1a <br /> ; r t, ;t7 G D F <br /> WASTE MANIF �- r <br /> 5:t3eneratoYs'Namt' dre t SM'Address(if different flan maiNng address) <br /> C,eneratar's Phone: <br /> 6. rarlsporter 1 Company Name U.S.EPA ID Number <br /> 1 � k . .Ep I Nurrther <br /> T s o er 2 m4pa-niy <br /> 8.Designated Facility Name and Site AddressU.S.EPA 10 Number <br /> 2-1`�l "\, 6, � v��{'trr. <br /> t1v �C�i <br /> Foal tys Phorre: �` <br /> 9a. 9b.U.s.DpT Description(including Proper Stuppin Name,Hazard Class,ID Number, 10,Containers 11.Tont 12,Unit 13.Waste Codes <br /> � and Pacnnking Group{rf any)) <br /> No. Type Quantity M.Nol, <br /> �I Y f� <br /> 1 <br /> r^7 <br /> 2. <br /> 3. <br /> 4. <br /> 14.Special Handling(nstnrctions and Additional Information ..r <br /> 15 GERATOR'SJOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment aroully and soca ely described above by the proper s ippirg na e,and are dasRified,packag <br /> ENed .... n, <br /> marked and IabeladlplaCirdacl,and are in all respects in proper condbon fa transport accardmg to applicable intemaloo gland national govemmentai regulations.If export shipment and I am the Primary <br /> Exporter,l cdsrlity that tha contents of this consignment wnform to Me lerms of the attached EPA Acknowledgment of Consent. <br /> I deaffq-that the'via9te minirnaation statement identified in 40 CFR 262.27(0)(01 am a large quantity generator)or(b)(if I am a small quantity generator)i5 trUe <br /> Generator'slORerbts'Printed7ypedName Signature Month Day, "YB <br /> 16. mationai Shipments ja <br /> t <br /> ❑{rnpon to U.S, �Export from U.S. Pott of enirylexit: <br /> Transporter signature(fcf exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt ofMateriacs <br /> �;ftlel'2 <br /> ner 1 Pdrite7fTyped Nam Signature;7 �,'�� Month Day Year <br /> v 1 r f a. Yy� <br /> Po d[Typed Name 1 Sign <br /> r <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Spsoe Quantity L1 Type Residue ", ❑Partial Rejection ❑Full R¢jecGon <br /> Manifest Reference Number: <br /> 18b.Aflemate Facility(or Generator) U.S.EPA ION umber <br /> J <br /> U <br /> Facility's Phone: Month Day Year <br /> W f SC.Signature of Altemale Facility(or Generator) <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e., to M recys <br /> !u 1 2. { 4. <br /> 20,Designated Facility Owner or Operator Certificaton of receipt of hazardous mate'als pvamd the manifest e><a a3 need in Item 78a Notice:State of California requires <br /> PrintedlTyped Name Mature and mail to <br /> generator to pho#o[opY <br /> �;,;i fL DTSC within 3D daYs: <br /> EPA form 8700.22(Rev.3.05) Previous editions are obsolete. ENVIRONMENTAL ^ ^ ^"Ann caCrRmentp'�9581x- <br /> HEALTH DEPARTMENT TOTAL P.02 <br />