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Pfeae pont ortp ,Forn dr3signed fk use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM fiAARDOt�S'. 1@gator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WAST MANIFE>�1�� z `k'" ;A1,000 ?.4 4<3a8000007951 SKS <br /> 5.Genie Ks amen Mailing Address Generators Site Address(if different than mailing address) <br /> AATN� FINANCE ADMIN <br /> CA 95330 <br /> Al <br /> enat tors Rhoitt3: „.9 $ 1600 <br /> V.TrAb 1,CompanName U.S.EPA ID Number <br /> 7.Trane glen 2 Company Name U.S.EPA ID Number a <br /> rt <br /> 8.Designated Facility Name and Site AddressU.S.EPA ID Number <br /> T4 , <br /> TENS.. IN--, 000618 <br /> 1.722 COOP 0' EK SOA <br /> DENTON, TX 76208 <br /> 9 40--48 3 5200 d TH017t76033`i <br /> Tac jt es Phone: <br /> ga T. 9b U.S.DOT 6escription(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> and PdcGroup(if any)) No. Type Quanfity Wt.Nol. <br /> P D006 COO? D008 <br /> 0 STIf LATIN BOTTOM13 99 U 3 82 PGIII25 <br /> FG#171 " DOG, D0107, D008 <br /> p' } <br /> 3. <br /> U <br /> I <br /> 14.Special Handling Instructions and Additional Information mCR 10a c}'2,6 80001897089 <br /> .. .1 t AH'D `['0 USE SUBSEQUENT CARRI S: 40343. 41038, 1681. 2739., 625 <br /> 15: GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> xx marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international andnational governmental regulations.If export shipment and I am the Primary <br /> porter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowtedgment of Consent. <br /> 1'�ertify that the waste minimization statement idenfified 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 /> Ge tors/Offerors PrintedlTyped N e Signatu Month Day Year <br /> 10tntemational Shipments v <br /> z ❑Import to U.S. ❑Export from U.S. w Port of entry/exit: <br /> -, Ttanspoder signature(for exports only): Date leaving U.S.: <br /> Tren porterAcknowledgment of Receipt of Materials <br /> s r i Printe/Typed Name Signature Month Day Year <br /> LZ e6' <br /> ( a PrintedlTyped Name Signature Month Day Year <br /> ncy <br /> r x <br /> 18a panty Indication Space ❑ Quantity. ., ty ❑Type ❑ j ❑Full Rejection <br /> yp ❑Residue Partial Rejection <br /> Manifest Reference Number: <br /> {nSb.Alternate Facility(or Generator) U.S.EPA ID Number <br /> y� Facility's Phone: <br /> 18c.Signature of Alternate Facility(or Generator) Month Day Year 1 <br /> .19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2• 4. <br /> �. . <br /> Designated FacilityOwner or Operator:Cerpfication of receipt of hazardous materials covered by the manifest except as n in Item 18a <br /> ted/Typed Name f <br /> Signature Month ear <br /> [ y 1P 70Q-22 Rev.3-05 Previous editions are obsolete. <br /> ' a (: i' ) : . ';_ ESi ATED FACILITY 1®GEE 7 <br />