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4 <br /> ,Please print or type.(Form designed for use an elite(12-pitch)typewriter.) Form Approvtd.OMB No:.?050-0039 <br /> F�l <br /> ID Number 2.Pa 1 of 3 Eme R ns Pgoo 4.Manifest TrackinNumber - +UNIFORM HAZARDOUSua=3L��f�3���� � I~F����4��—� r+�t� 002286334 g ��a7 <br /> WASTE MANIFEST <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> '?r TZM t?krje_t�tt_f ES <br /> CA <br /> Generators Phone: 2 547—i 963 <br /> 1.Ttags�peodde1clLorqQayNar�e Y SM <br /> T� ' � �� U.S.EPA IDNumber TX 00t21 06 . 0 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> ..7---,_ _! _._ ..•^�sir r:��J c�-t�b-+t� <br /> 8.Desigriatetl Name and Sitio Add%i 778AF ET J—K'1t,:E-N S'YS f'tmM=s a INIC� 740 a U.S.EPA- <br /> ,­ <br /> FA ID Number ' <br /> 1722 COOPER bRE RO <br /> Fad' s Phone: <br /> ga, 9b.U.S.DOT Description(incliAnrg Proper Shipping Name,Hazard pass,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Padding Group(d any)) No. Type Quantity WtNol. 13.Waste Codes <br /> cy 1. ZRQ W96TE F_ At1P''A3;--=— LIQUID", N.O.S. DIM P L3@$1 214 Lr,ti S <br /> 3 _V'1992` PE :1.1 (DOW) <br /> Z 2.LU <br /> 9 <br /> 3. <br /> I <br /> i <br /> 4. I <br /> t <br /> t <br /> 1: <br /> P4�HR EMERGENCY #1--80 --4158-1760 (S F&Y—KLEEN — 94.138) <br /> SK AUTH;, TO USE SUBSEQUENT CARRIERS a4i.078�41471 a;681,,827.3%85399 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare thatAke contends of this consignment are fully and accurab*described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper oondtion for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to He terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(d I am a large quantity generator)or(b)(d aln a smaq quantity generator)Is true. <br /> Generatoes/Offeror's Printedllyped Na a Signature Month 4 Day Year <br /> � f <br /> t' F / CiJ�1 <br /> 16.InternatioriM Shipments <br /> n Import to U.S. ❑Export from U.S. Port of entry/exit <br /> Transporter signatureSforts only): Date leaving U.S.: <br /> 17.TransppaerAclowwledgment of ftpipt of Materials <br /> Trans ter 1 Printed(Typed Name?` /�� Signatha ��; Monti Day Year <br /> Z a e Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type LJ Residue Partial Rejection <br /> 1 El Full Rejection <br /> Marifest Reference Number: <br /> 18b.Alternate Facil' Generator) U.S.EPA 10 Number <br /> V <br /> FaclNtys Phone: <br /> w 18c.Signature ofAitemata Facifity(or Cenerator) <br /> Month Day Year <br /> Q' <br /> Z <br /> y19.Hazardous Waste Report Mamgement Method Coles(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 4. <br /> 20.gesigrta ed Faa$tyCfwrer or Operator:Certificatlon of receipt of hazardous mataials covered by the mtlni(eat rlded M Item 18e <br /> P 1Ffyled NaT a r' V �' Day <br /> f , 'r' r. /(,- <br /> EPA EP Form 87 22 v 305 Previous editions are obsolete. 1 <br /> t +� 4c/�r44 � CJ DESIGNATED FACILITY GENERATOR <br />