|
e
<br /> t8K '914TP# 227102919
<br /> 7
<br /> Please print or type-
<br /> REC�IVED 12018,
<br /> Form Approved,OMB No,20500039
<br /> -
<br /> UNIFORM HAZARDOUS 1.Generator ID 4umber 1!P :1 Pigg FE—Mefae,=-Rospm 4.Manifest
<br /> CAL0001,46360 I gf, .—TWO,98,2!fto 1,i
<br /> () Tracking Number
<br /> WASTE MANIFEST J
<br /> 5. 6724841 SKS
<br /> Generator's Nari)ls and Malting Address Generator's Site Address(it different Ilion mallin paddron)
<br /> Cisco Air Systetps,,Illl: .0
<br /> '114 L
<br /> " 71;h at
<br /> 3MRAMENA CA 9.5816-3201
<br /> Generator's Phone: 916...444-2,t54-5
<br /> 6. " rOYSTEM U.S.EPA ID Number
<br /> MVRIN, I�NC
<br /> TXR000081205
<br /> 7,Transporter 2 Company NBme
<br /> GI-17FIN HARBORS ENV IR qulhl�, NTAL SVC INC. US.EPA ID Number
<br /> 8.Designated Facility Name and Silo Address CLEANHAR BURS 'OF -Bun-oNwILLOW U.S.EPA ID Number
<br /> 2500- 1-OKERN ROAD
<br /> B�T'raNWILLOW
<br /> Facility's Phone: CA 93aor CAD9@0675276
<br /> go. 9b,U.S.DOT Doscdplion(including Props'ShIpPlq Name,Hazard Class,ID Number, 10.Containers li,Total
<br /> lim and.Packing Group(if any)) No. "Typ 12.Unit 113.Waste Codes
<br /> 1._Aott- Quantity WLNOL
<br /> NON RCRA ISA Ai WASI'E LIQUIDS
<br /> 0 '(OL, CARBON) I 41-'Prz=—
<br /> 2. P 141
<br /> Zh
<br /> LU
<br /> 4.
<br /> 774specisi
<br /> Handling.Instructions andAdditional Iriftit"nation
<br /> TSD i M C 13,1793 MO..,
<br /> 24H ENEROENCY#600—
<br /> .48t3"1'7t-O-CFl/BK/TFI-.Co.ntra.et retained b Venera or lbonfers agency at.tthor-it
<br /> an initta' l trrans:pd* tgr t'6 A: fid y
<br /> ireby dedare that the contents of consignment-hre fully and accurately 'bed aboyo by-fita propershIpIft nams,and aretlasillied,packaged,
<br /> 16. GENERATOR'SIOFFEROR'S CERTIF101101, I hEllns='t V'A 013 QW11161-iltarl �, behalf.
<br /> marked and lobetediplacarded,and are in all re:)sets 4proper condition for transport according l6*6pplicable International and'n regulations.It export stillintentanol I am the Primary
<br /> at go
<br /> Exporter,I cartily that the contents of this consk t confom).to the terms ofth'o-altachad EPAAcknr,,—d,7m,,n... o,,erit,rl� governmental . ti
<br /> (lify,that the waste minimization statemeh.tic me d-In 40 CFR 4262.27(a)(If I,am a large quantity g erit6r)or
<br /> a ittot) (b)I,
<br /> rilifil (40 M a sma qu litygenerat6r)Is true.
<br /> 'Generato Offorcies Pn'ntedfrypW:Na Sr atureponth Day Year
<br /> I',IZ9 I A
<br /> 16.International Shipments
<br /> Li Import-16.1.S FIE
<br /> Z ' Export from ti S.. P o on�rylwdl:
<br /> Transporter signature(loraxporls:only): 0 in(
<br /> W- 17,TransporterAcknowfocigment.of Receipt of Molerlah
<br /> UJI Trans PrintedlTyped Name
<br /> Signal�1� Month Day Year
<br /> -
<br /> iL
<br /> Transporter 2 PdnMrryped Naga
<br /> Signature,
<br /> Month Dq�— Year
<br /> "qL(ZA 'It.
<br /> 18,Discrepancy
<br /> i Ba.Disqrapancy Indicallon'SpaceType -',,Id
<br /> n Quantity F
<br /> 0:0 PartVajection Full Reject on
<br /> Marilles(R4forance Number.
<br /> 18b.Alternate Facility(or Generator)
<br /> U;S.EPA ID Number
<br /> LL Facility's Phone,
<br /> Lj 18c.Signature ofAltemale Facility(or Generator)
<br /> )nth Day Year
<br /> 19.Hazardous Waste Report Management Method Codes codes for hazardous waste treatment,disposal,and recycli g,Gystoms)
<br /> j
<br /> 4.
<br /> 20,Designated Facility Owner or Operator:Codification jifrec�elf)t oflitizardo00thaterials coveted by the manIfost*exoo0tjas n ediniterlitl0a
<br /> Printed/typed Name Signature Month Day Year
<br /> FPq FgV,87700-22(Rov.12-17P Previous edlUons-arE obs,
<br /> DESIATED FACILITY TO GENERATOR
<br /> Zj
<br />
|