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Form Approved.OMB No.2050-0039 <br /> �y yryespQnse Phone 4.Manliest Tracking <br /> 4 2 01 J J K <br /> 'ase print of type. 2.Page 1 me n 46G O <br /> 1.Generator ID Number of <br /> UNIFORM HAZARDOUS C A P 0 0 0 3 0 3 7 1 9 n mailing address) <br /> WASTE MANIFEST O i'ScCs -1 <br /> 5.Itt ..19 Address 37.99385-121.3482� J <br /> PO BOX 711 STOCKTON CA ���. <br /> SAN FRANCISCO CA 94120 0 - 5 0 1 1 <br /> 6 5 9 U8 EP-A I�{''e��r0 0 2 6 9 5 4 8 <br /> Generators Phone: A <br /> 6 Tfttj4b0tyM OUTSOURCING LP U.S.EPA D Number I O <br /> W c �+ <br /> 7.T ans er 2 Company Name <br /> l//11 U.S.EPA ID Number <br /> LLC <br /> 11855 IM-II'fE ROCK ROAD C A p 9 8 0 8 8 4 1 8 3 <br /> RANCHO CORDOVA CA 95742 <br /> 916 351-0980 13.Waste Codas <br /> Facility's Phone: ID Number, 10.Containers 11.Total 12.Unit <br /> tion including Proper Shipping Name,Hazard Class, Quantity WtNol. <br /> 9a. 9b.U.S.DOT Description( No. Type D0� 181 <br /> HM and Packing Group(8 any)) IS 19141:51''E;SIC"11LIC11" irl. . <br /> ' 0 0 4 DM 01200 P <br /> o X 9,PGIII <br /> w 2 <br /> Z <br /> LU <br /> c� <br /> 3. <br /> 4. <br /> 14. tadfT7q1aSlnfn PGT2 0 03 011 4X5 5 <br /> 9B.1) 529038 DEBRIS CONTAINING LEAD AND MERCAPTAN <br /> 11 shi name,and are classified,packaged, <br /> nment are fully and accurately descr bed above by the proper Pfnn9 shipment and I am the Primary <br /> re 111 on for transport according to applicable international and national governmental regulations.If export pme <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of thrs consig <br /> marked and labeledlplacarded,and are In all respects in properEPA of Consent. <br /> nment conform to the terms of the attached generator)or f o en a s all qu 'ty gene s Month Day Y r <br /> Exporter,I certfy that the contents of this consi9 d I am a large quantity <br /> I certify that the waste minimization statement identified In 40 CFR 262.27(a)( Signature <br /> Genpy�gr :ROB GILBERT <br /> y� El Export from U.S. Port of entry/exit! �-- <br /> 16.Intemational Shipments import to U.S. Dale leaving U.S.: <br /> i— <br /> X Transporter signature(tor exports only): <br /> 17.Transporter Acknowledgment of Receipt of Materials Signature <br /> LLI T a ame Month Day Year <br /> 0 <br /> O <br /> CL <br /> Z iter 2 PrintedlTyped Na <br /> 9 ❑Full Rejection <br /> 18.Discrepancy Residue ❑Partial Rejection <br /> 18a.Discrepancy <br /> Indication Space ElQoanUty Type <br /> Manifest Reference Number. U.S.EPA ID Number <br /> r i 8b.Ntemate Fadfity(or Generator) <br /> J Month Day Year <br /> U <br /> LL- Facility's Phone: <br /> LEI 18c.Signature off emate Faality(on Generator) <br /> or) <br /> dins terms) <br /> Z Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling Ys 4 <br /> N 19,Hazardous Waste Report Management Melhod 3. <br /> 2. <br /> UJ I <br /> H <br /> b the man'rfest except as nded in Item 18a Month Day ear/\ <br /> 20.Designated Facility Owner or Operator CerbflcaWn of receipt of hazardous mate eats covered Y S gnature 3 t/ <br /> Pr nted/Typed Name 11 , <br /> p 51GNATED AGILITY TO EPA's e-MANIFEST SYSTEM <br /> III lie iborls are obsolete. <br /> EPA Form 8700-22 Rev.12 17) Previous ed ^ <br />