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776432 <br />001? . 0878 <br />Fnrm Annmvcxl A RW?(L50M39 <br />teA hOfTll 1:11UU-L1 (Kev. JIJl 1) erewous eolllons are ODSOlere. UtblUNAI MU r-ACtI)Ll 1 T It U ur_rvr_r1M1 %Jn a IMI F- Jnr nW.%d%R rrI <br />04-10-07P1-10166.1474 _ <br />UNIFORM HAZARDOUS <br />1. Generator O mbar "'" <br />M <br />3. Emergency Response Phone <br />4. Manifest Tracking Number <br />001948886 JJ K <br />WASTE MANIFESTCAROMI <br />_ <br />5. Generators Name and Mailing Address Generator's to Address (if different than mailing address) <br />LODI CHROME LODI CBRO[E <br />315 N. NAIL! STREET 316 N. RAN STREET <br />21 - <br />GeneralalsOW4.'A 95240 (215)361-4691 LODI CA 95261 (20911368-4611 <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />6. <br />x 6401 <br />2 1 st CENTURY EMI"rCAROM <br />7 Transporter 2 Company Name'. U.S EPA ID Number <br />a. <br />8. Designated Facility Name and Site Address x '_"" U.S. EPA ID Number <br />21st CIlntury EII <br />2195 Newlands Dr. East <br />Facility's Phone: Fernley, NV 89418 (775) 575-2761 NVD980895338 <br />93. 9b• U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />NM and Packing Group (if any)) <br />Quantity <br />Wt./Vol. <br />1 WASTE MIIC LIQUID, CORROSIVE, INORGANIC, N.O.S. (COPP93 CTA110 <br />, <br />F117 <br />o <br />SODIUM HYDROXIDE) 6.1 (8) 043289 PGII 'TOIIC' KNOW <br />? <br />TP <br />65D <br />G <br />2. WASTE TOXIC LIQUID, CORROSIVE, INORGANIC, N.O.S. (COPPER CTANID <br />, <br />Y118 <br />" <br />SODIUM HYDROXIDE) 6.1 (8) 913289 PGII 'TOXIC' ERG(154) <br />DF <br />T <br />P <br />3. <br />4. <br />14. Special Handling Instructions and Additional Information <br />(1) 366457-11 - COPPER CYAIID1 TANI (2) 366458-11 - CAPPER CTI,NIDE TANI <br />15. GENERATOWSIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are ciassifiec, packaged, <br />marked and labeledlplacarded, and are in all respects in proper condition for transport according to applicable intematdnal and national governmental regulations. If export shipment and I am the Primary <br />Exporter, i certify that the contents of this ccnsgnment conform to the terms of the attached EPA Acknowledgment of Consent. <br />I certifythat the waste minimization staterriert identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. <br />torpslolferoes Print &Typed N�amm%e�, Signatu Moonnth Day Year <br />C� v / C7'=.7>j- <br />I E. Intemauon Sfi parents 11 Import to U.S. ❑ Export from U.S. Port of entrylex t <br />Z <br />Transxrter signature (for exports only): Data leaving U.S.: <br />17. Transporter Acknowledgment of Receipt of Materials <br />Sidra Month Day Year <br />T nspohq mtedlTyped Name <br />a <br />A�� CL 'o A o3 07 <br />ZTransporter <br />2 Printed/Typed Name Signature Month Day Year <br />rY <br />H <br />13. Discrepancy <br />13a. Discrepancy Indication Space Quantity Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number <br />lab. Alternate Fadity (or Generator) U.S EPA ID Number <br />U <br />LL. <br />Fadhys Phone- <br />18c. Signature of Altemate Facility (or Generator) <br />Month Day _ Year <br />QW <br />2 <br />y19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment disposal, and recycling systems) <br />4.LU_ <br />20. Designated Facility Owner or Operator: Certification or receipt of hazardous materials covered by the manifest except as 2in Item 18a <br />Pnnt"Typed Name Signature ( __ - Mond) Day Year. <br />�o 0 <br />teA hOfTll 1:11UU-L1 (Kev. JIJl 1) erewous eolllons are ODSOlere. UtblUNAI MU r-ACtI)Ll 1 T It U ur_rvr_r1M1 %Jn a IMI F- Jnr nW.%d%R rrI <br />04-10-07P1-10166.1474 _ <br />