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RC Form 540 U.S.Nuclear Regidatoly Commission S.SHIPPER-NAME ANDFACILICY SHIPPER ID NUMBER ]-FORM SW AND 340A PAGE I OF I FACE(S) KMANFMNUMBER <br /> SCM Safety FORM sal ANnMIA I FAGE(S) TM96 <br /> FOKM UNIFORM LOW-LEVEL RADIOACTIVE CIO American MastaTech AADDiTIIDHALINF0FORMATION 0PAGE(S) <br /> f <br /> WASTE MANIFEST 1330 Thurman St C3 COLLECTOR '+ VAL 3PAGEP <br /> Lodi,CA 95240 LJPRGCF350R CONSIGNEE-fi--dF.AtyAddress 13NTACT <br /> Shipping Paper Environmental Mgmt.&Controls,Inc. Steven May <br /> 0GEHERA-MRTYPE 3106 S.Faith]-Tome Rd. <br /> .SERPERMITNUMBER SHIPMENTNUMBER I Turlock,CA 95380 TELEPHONE NUMBER <br /> 1 EMBRGENCY7ELEPEIONENVIdBERflnc0.daAr0.Cada1 <br /> (714)745-5211 ONTACT TELEPHONENUMBER (2(14(]67-1102 <br /> AWANIZATION Earl Thomas (925)362-2265x109 <br /> Thomas Gray&Associates,Inc. ri CARRIER-NAME AND ADDRESS EPA ID NUMBER KNATUR.4 IATk <br /> 2_Is this an Exclusive Use Shipment]3.Tatal number of 2 Drtan(s) Thomas Gray&Associates,Inc. CAD 066151 648 <br /> .& Eed 1205 West Barkley Ave. ICXEFMflCA7*0N Mts iac,,,Py ur Oeaemaarrned mge ay arc prdPer�claardied,dnerbed pxke�d mtrled and <br /> YeE0No� p NIPPING DATE kdxdarcupnpPc _di!imfnry 0—dintodnxppkabeRpW*eafdkDlPwamlofTnmp%tno <br /> Orane,CA an this manifest. g 07117/2020 +i.also orilles Bal thema wl;;,rwckV,%,[.arhd,and labeled and are in pFgw-Wi[icn for�.ppnamanddigwalw <br /> uraccordrnce wife IEe aspficabk req-dwwm of 10 CFR Pam 20 and 61, w an mouletku <br /> �77 <br /> 4.DOES EPA REGULATED WASTE EPA MANIFEST NUMBER GNTACT TELEPHONE NUMBER <br /> REQUIRING A MANIFEST ACCOMPANY 1 Richard Gallego (714)997-8090 <br /> THIS SHIPMENT?If"Yes"provide MaDifea[ LTIA71URE A.&. do'A"wbk lcdr ag wnslrraocip DATE lllliURIZFD SIGNATURE fITLB ATE <br /> NQ <br /> 13. 16.TOTAL PACKAGE lA <br /> 11 DOTLABEL IR INDNmIfALRABpNVCLmG. IZ' 1&TOTALWEIGHT nrldTWdCATDW <br /> Il.nB DRPAATMFNf OFT¢ANaPo;r'ATION O[-4CR6TIDN -RAD[DALTIYC' AINDEN[r I1 Pl{YBICALANDCHY[AMAI-FORM ASA' <br /> INDEN 1'-Iaidtod Pq4l1CPR4199.111(gJ) OR YOWM& NfID1YEl10P <br /> M09 .0 CLAW MCI[Af-F <br /> UN29I0,Radioactive material,excepted package-limited quantity ofmaterial,7 NA NA Ligai".01%uranyl niu*c in water U-Nat 7.4E'7 (2.0DDE-8) NA 4.6(IO 1Its 202W1 D01 <br /> UN290,Radioactivemalmal,Cxi limited quantity ofmateri 7 NA NA Li uid10-Oi%ur ]uitraleinwater U-Nat 7,4E-7 2.000E-8 NA 4.6 kg 202WD02 <br /> eptedpackage- 9 ry al 9 "Y ( ) (IO lbs) <br /> FOR CONSIGNEE USE ONLY IIII[IIII�IIIIIIIIIIIIIIIEII�IIII�IIIII <br /> Email:ethomm@scm-safety.com Disposal Site(s):ES Clive <br />