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V/ <br /> Please print or type.(Form deslgn&d 6r-use on elfte(12-pitch)typewri{er. <br /> } Form Approved.OMB No.2050 4039 <br /> A <br /> UNIFORM HAZARDOUS i"C,etierator ID Numbai 2.Page i of 3.Emaigeniy Respdnse phikle 4:htpnNosi�rsddng.NOmw, <br /> F1 WASTE MANIFEST CAL 355747: 1 415 X23-8772 L <br /> 5. aerators Na'ma and Mair#_ Address <br /> enerators 'te Address(rf i' t n maiing address) <br /> JJWVeRGAL SVP ReCYG11W .AfY1 IMMM Moijorwa <br /> 3200 S.8 Dorado St. <br /> Stockton,CA 96206 <br /> Generators i?hona: <br /> 6.Transporter 1 Company Nama _ <br /> U.S.EPA ID Number <br /> Union Paeft Unes CO <br /> 7:Transporter 2 Campany Name .1 <br /> U.S.EPR ID Numtrer <br /> 8: igAaIed Faa7ty Name and 1te Addrass U.S.EPA ID Number <br /> EMC <br /> ifif Mist 1440mV 123 <br /> Faaals Ph i C Chita,Lr 04620 LGA <br /> ga. 9b.'us-DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> 11.Teta) 12,Unit <br /> tint and Pad it g Group fd any)) No. Type Quantity WfJVoI. 13.Waste Codes <br /> f _ <br /> "I Ell <br /> HG <br /> w <br /> 2. _. <br /> 4 <br /> 14:Speaal Handling Inshdons endlAddiSonai Information" <br /> RRA der � <br /> 15. GENER 4TOlt'SK}FFERdA' cam.,Hier by declare 0a,Dia"contents of this consignment are fully and accbratety described above by"proper shipping ria ria,and are clssstfied packaged, <br /> marked and labale'dlplacardsd an¢ iii all respecie in proper condition fortransport according to applicable international and na0o W governmental r�utatiorou,if export shipment and I am the Primary <br /> Expodar,I Drat 04 contents-V cons[gnment conform to the terns of the attached EPAAdawmadgment of Consent. <br /> I cert fy that _ m nim' " t identified In 40 CFR 262.27{a)(d i am a large quantity generstnr}ar{b)Cd I am a small yuatrtiry, tar)Ls tare, <br /> I 1 ? P2 <br />' .r 1s.International S <br /> LJ Import to U.S. ❑Export fmm U.S. Port of entryte* <br /> Tramr s atu-, .' ports on : Data teavE <br /> lP�IWO, <br /> I 662_2 ransporterI.. 1�"l It•�.��lA�4 �._,. _. ...... G� `•-�5 � :. <br /> 'nypad arra _._ <br /> 'ranspoder M11,1841 I ypsd Name pna rEr <br /> I 18.Disaeparrcy .:,. _._ _. ... ... <br /> 18s.Discrepancy lndica0on Space ❑ Quantiy ❑Type Residua Partial Re}ac0on Full Rejection <br /> Manifest Reference Number. <br />' 18b.Alternate Fea fij{oi GenereUx) _. , , <br /> U.S.EPA Ip Number <br /> C) <br /> � Faai' s Shone: <br /> Uj <br /> 18c:SignaturedtAJtemata Faa3iry{ar t;este+atbrj _,- :..., .. . <br /> tlkn0r ' tray Year-, <br /> 2 <br /> "tis Hazardous Waste Ma <br /> CD ." .. Report nagamant fAethad codes lie codas foF tiarardous waste treahneiit�deposal aixi <br /> + Yd n9 � <br /> t f p a .._.., <br /> 2tl.[}esignated Fatsiity Owner or operator.Cei0fication of receipt of fiazerdoris materials covered by fhe marafasi'exc�pt as rated lr Item 18a'_ ; <br /> Pdn ypad Name. <br /> Ti <br /> -:.Y'V <br /> l <br /> EPAForm'67QD-22(Rd v.3 65) Previoi`s etli4ons are obsoleis. , <br /> IGN TE DFACILRYTrGENEWOR <br /> i; <br />