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f; <br /> Pease print or type,(Form des' ned for use on elite(12-pitch;typewriter.) Form Approved.OMS No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C' A C 0 L ? 6 1'No 9 E, O 1 � 001382 <br /> � 6 JJ <br /> 8G0 2i-.479 <br /> 5.Generalofs Name and Mailing Address s <br /> �tC Judy diol C C3rRpt,etl Generator's Sile Address Of different than malting address) <br /> �"ADIO SHACK CORPORATION AFN 175-170-18 175-170-19 17r1 <br /> 300 FtADIC SHACK DRIVE,MAIL STOP C-1`4-30 24 <br /> FORTWORTH TX 75102 _TOGf`T1td CA 9-62015 <br /> Generator's Phone: 4 1 p, - ? I 4 <br /> 6."ronsporer 1 Company Name U.S.EPA ID Number <br /> Ecology%orhral IrlcitastriYs G' L. D 9 S 2 0 3 0 1 ? 3 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 0.Designated Facility Name and Site Address U.S.EPA ID Numc; <br /> EC�,logV Control Industries <br /> 255 Parr DDUi,yard <br /> E Rict-Ireond CA 04801 <br /> Facility's Phone: 1U% 2H- G 0 1 s tl E, �• 9 <br /> ga_ 9b.U.S,DOT Descipflon[including Proper Shipping Name,Hazarc Class,ID NurrtCer, 10,Containers 11,Total 12.Unh <br /> HM and Packltg Croup(K any)) 13.Waste Codes <br /> No. Type Quan2y V'AJvd. <br /> lflori-RCRA Hazardo,is'Waste,Stolid <br /> (2MPT:/STDRAGE TAN)<tS) 512 <br /> fl s3 1 <br /> TP 00i53 P <br /> 2. <br /> :C9 <br /> ii <br /> i 3. <br /> 4. <br /> +' 14.Special Handling Instructions andAdcklonal In motion <br /> li tTY Z m{PTY STOFtnGE TANX- TAXK 23295 <br /> EC:E JOB :## 52T2257 <br /> "TrEAR PROPER PPE t M1•d HAbrDLING. WEIC-FTS .'e24D VObM.IES AL12•E APFRO;. ID TE_ <br /> 15. GENERA70R'SIOFFEROR'9 CERTIFICATION; I hereby declare that the contents of this consignment are hilly and accurately described above by the proper sh:ppatg name,"in classified,packaged, <br /> marked and libeled/placarded,and are in all respects M proper condition for transport according to applicable tnternagaialand national governmental regulatfons,if export shipment and I am the Primary <br /> Exporter,I eeitlfy that the contents of this eonsignmmt conform 1a the leans of the attached EPAAcknowledgment of Consarrt. <br /> I certly i tat;he waste irdrilmization statement Identified In 40 CFR 262.27(a)(Ill am a large quaintly generator)or(b)(III am a small quaaiky generator)Is We. <br /> Geng'ator'sfofleroes PrirdedRyped Name lu h Morih Day Yeer <br /> : a '6.Iniersuttitxral5htpments <br /> ❑Import to U,S. ❑Export from U Pon of entry/exit <br /> T.anspo.tier s gnatiure'(forexpohs only): Date leaving U.S.: <br /> 17.7rartsrorlerAcknovAedyTrmnt of Receipt of Materials <br /> aTran rer 1 Printed,7yped e <br /> O ��Q; y - Sin Month Day Year <br /> 4 Transporter 2®Pri ledvTyped Name <br /> S lure Mord1 Day Ye1r <br /> 16.Discrepancy <br /> 16a.Discrepancy Indication Space ❑ Ouarrilty El Type <br /> ❑Residue ❑-ardat R*dion ❑Full Reje:Ion <br /> 18b.N1emaie Facfiky(or Generalor) Manifest Reference Number: <br /> U.S.EPA ID Number <br /> L&- Facilkyk?hone: <br /> C1 l6c.Signature of Allerrale Fa;4INy(or Generato') Month pay Year <br /> d <br /> 1:.Hazardous Waste Report Managenent.Method Codes(i.e.,codes for ltmrdous waste treatment,disposal,and recycliig systems) <br /> Uj® i. 2. 3. <br /> 4. <br /> 20.Designates FacilityOwner or Operator:Certification of receipt cf hazardous materials covered by the man€fest except as noted in Item 15a <br /> Pr.Med/Tpped Nane Signature Month —Da—y----.M®EIn <br /> • f ®® <br /> FAFcrm i3700 22{Rev.3 05j Previous editio.ts are obsolete. SIGNATED nwf <br /> FACILITY TO DESTI ATION STATE(IF RE®UIR®% <br /> t'd60ZCSCZOLSL puoulyol� - I O d9L S0 90 SO®®®® <br />