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Fro.... LMT, Inc. Page: 2/7 Date: 1/4/2012 11:08:,a AM <br /> 7.142 <br /> Please pdnl or typo. Form designed for use on elite(12-pitch)typewrites Form Approved,OMB No,2050.0039 <br /> UNIFORM IiAZA10003 1,Generator Ip Number 2. <br /> C�iL0t71Qf3.?`'5�2 Pg1 TVIONVA-77N,7. <br /> 4.Alffl6 Tek��1 <br /> WASTE MANIFEST <br /> 5 <br /> 5.Ganeralor s Name and Maling Addroea GOnOVVS$lto Addroz(if dtlfcronl ItWn maipng addfeRa) <br /> zM TECHNOL.OGIES <br /> 1gle SHAW RD <br /> ST'OCKTON CA 9521 <br /> Generator's Phone: 209--547•-1955 <br /> a.Tran, onor 1 Qom an Namo U.S.CPA ID Number <br /> MEIITYWKrEEN SYSTEMS, INC. TXROOIBCS0930 <br /> 7,Transporter 2 company Name U.S,EPA 10 Number <br /> 8.Ueslgnatod Fealty Name and Silo Addross af�FE1 Y_FiLEFh{ Y�,7 f M5 I NC. u:�, p Number <br /> 17r""22 COOPER CREEK R011ID <br /> neNTnsv, Tx '762013TXDO'77 <br /> 940-483-5200 Fs03�371 <br /> Facility's Phone: <br /> 9o. 9b,U.S.DOT Drscripllon(Including Pmprr Shipping Name,Hazard Class,10 Ntimbor, 10.Contalnem 11.Total 12.Unit q3.Waste COdrrS <br /> IiM and Packing Group(if any)) No Type ouantly mlfvol, <br /> tx X 1. RG! WnSTF FLAMMa1_C Ligyipx, N.n.,5. DM P D91@1lOUTS <br /> (P--CFILnROAENTQTRIFL UORTDE) <br /> 3 UN1993 PG III (DO01) <br /> � 2 tr. <br /> i <br /> 3, <br /> i <br /> i <br /> I <br /> 4. <br /> i - <br /> 14.Special Handling Instr0iona and Addklonal information K SHIP 3142935 CSf's R <br /> 1}EI�C#�th 128 <br /> 124 HR EMERGENCtY #t--800--468-17'60 0s'AFET - -- '341310 <br /> IJTH°LI Q USE zULAh 131JEN'i t-ARRT x.4107,$ 41471 915131 F32739 85399 <br /> 15, OFNERATOR'SIOFFEROR'S CERTIFICATION: I horaby declare that the contents of Ihla connignmenlam fully and accuratolydoscdbed above by the proper:dtlpping name,and are closollted,packaged, <br /> marked and labeled/pfuarded,and aro In ail rospocta in proper condition for tranap❑n accordlog to applicable International and hatIonal governmemal regulations.Ir exparl shlpmanl and I am the Primary <br /> Cxpodor,I certify that tht contenly of this consignment conform to N terms of ftaltadted EPAAcknowlodpmenl of Consent <br /> 1 certlN that me waste mlnfmization alatemenl kfentlged In 40 CFR 282.27(a)(if I em a large quandly generator)or(b)JA am a smafl ouerAy generates?is Into, ; <br /> Onne�ratd U Wno <br /> if � ,..�,,�r,.►.,. WLR <br /> —+ 16.Inlornallonal Shl W r <br /> i:- Import to U.S. ©Fxpon from U,s. Port of enky/axll: <br /> z Tran ofsi nalure for ox orlsoni <br /> M17 ranspOnorAcknowledgmrAt of Racelpt MalOdals ^` <br /> Tr,nsporter 1 PrinledtTyped Nima gnaturd Month+ <br /> Oa. <br /> !aA&Y"car <br /> lianap0na "11 <br /> 18.blacrepancy ((�� <br /> 1Be.Dfacrepancy Indicellon Spam ❑ ouantlly Type t—I Reaklua Penial Raj'P J FuN Rolocf on <br /> hI <br /> Manifest Reference Number; <br /> 18b,Alternate FaciYly(Or Oanenta) U.S.EPA 10 Number <br /> U <br /> d Facilil's Phone: <br /> W ,18e.Signetura of NtOmnle Fecklly(or Generator) Morh pay Yn ; <br /> a ' <br /> zl � <br /> Hazarclous Waste Rrperi Polanegnmonl Method Codds(Is.,codas for hazardous waste treakrrent,dlyposal,and recya'Ing!:ystgma) <br /> ut <br /> o ,1 <br /> 2 <br /> So. nd Facglty Ownor or 0 ator;Cerlificaann of nxeipt of hazardous mntorlNs covered by d10 manifest ezce ased In Ile Ba <br /> ' IX)d 04 <br /> Signature <br /> 71�✓�L G•l S a'fir` only Da <br /> GP F�FrtnBZ% (�R i�3�Ogf4%ious adilions are obsolete, f)F NATt:II FACILITY iT`/fO GtF 7EyATi(7N STATE(IP RE(OfJI. <br /> VJ��4 3 VJ This fax was received by GFI FAXmaker fax server. <br />