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:4,1C 7707 <br /> Tg <br /> $q <br /> 'K tyf NdNe,�Oi S M <br /> 0061439 �2Sk <br /> ItasR ptrnf jFarin desigried:foc ttse:onetife(12-pitch}typewriter.} Ftimt Approved.OM8 No.2Li5r } <br /> 1.Generator ID N Number 2.Page 1 of .E �sp nse Hth 4.Manifest Trackln Number <br /> 1NIFE31fM tr�zAti�ous M41638 <br /> 0 0 6 3 2 <br /> Ih14sTE"�IAiVIfEST SKS <br /> S Generetofs Name and Mailing Address <br /> Generators Site Address(if different than mailing address} <br /> bL <br /> no <br /> st <br /> CIA 915W" 9 1 <br /> " iii Generator's Phone: " _ <br /> 6 f C a S4r d — -- - — U.S.EPA ID Number T ' $.t Zs <br /> U <br /> 7 Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Desi nated Facility Name and Site Address ^ f fT U.S,EPA ID um er <br /> ILKINGTON CA 9W44 <br /> Faciiily's Phone: <br /> ga 9b.U.S.DOT Description(inciuding Proper Shippng Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit <br /> HM and Packing Group(f any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> C5 (01L FTLTERS'�, <br /> �5 <br /> -36 <br /> o_ <br /> 2' 2. <br /> U, <br /> 3. <br /> 4. s <br /> 14.Speoial Handling instructions and Additional Information jfi4,r.> �� �i 2"r '��,.,, �,��r <br /> �: s�-.g <br /> -A �,49 FW"-- —8 T Oki <br /> 11,4 � N � �,_FZ kr OEN TO w. .�,f »N,6. � U C S AS a s <br /> 15. GENERATOR'51OFFEROR'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 /> meN?d and labeledfplacarded,and are fn all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,i cartify that the Contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 4f1 CFR 262.27(a)(if I am a large quantity generator)or(b)(ff I am a small quantity generator)is true. <br /> GeneratorslOfferors PrintedlTyped Name Signature Month Day Year <br /> <,. <br /> Vr 16.International S€iipmentsI <br /> i-• ❑import to U.S. ❑Export from U.S. Port of entry/exit: <br /> 2. Transporter signature(for exports only): Date leaving U.S.: <br /> E 17.Transporter AcknovAedgment of Receipt of Materials <br /> T s er 1 PrintedfT Name Signatu MoA Day Year. <br /> Cr <br /> CL v5: <br /> -0: Transports Priri dtr 5Arne !! Signature Mo Da Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quanti <br /> Type T 1:1due Res <br /> ly ❑ ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> W Facility's Phone: <br /> Lo 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> C7 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLJw <br /> 1. 2. 3. 4 <br /> r <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except noted;'..Item t8a <br /> PrinledlYyped Name Signam M4hth Day Yedr <br /> 13EPa p�rns8790 ( y,3 0 ), reviaus editions are obsolete. SE I. Ik'I FACILITY TO DESMAT'ION STAT (:IF'A'EQUIRP—D]i <br />