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'K E13094 <br /> SHIP# 230 77 <br /> Please print or type.. Fgirp-QPjrroved.QMB No.2Q5D 0039 <br /> UNIFORM gAZIaRDOUS: 1:Generabr ID Number 2.Page 1 of 3xF1n �y R' gse��o e� 4:ManlfesE Tlaeking Number <br /> WASTE MANIFEST S'KV <br /> Generators Name and Mailing Address Geberatoes'Site Address(I'diiferenl than mailing address) <br /> Esca1905 :Hchem��i Avp VVI <br /> ��� Pre�mser F3ranf�� TI:u. <br /> ECA�.i3`v 9�3c4—QtkQ�s .. <br /> Generators <br /> {ePrtiorletp�an� rtia S <br /> 8.off C.L �R�re-MI W!�'a�'_T�- 8 C U.S..EPA ID Number <br /> . r <br /> 7.TansporterD' 6mpany Name % U.S,PAID Nurnber <br /> I MAI <br /> B:DesigmtedFaalltyName and Site A¢cess` SAFEI-Y— A-EENYSTEP9$,I i.N[. US-EPA IDNumbei <br /> 60u0' 88TH 'STREET . <br /> SACRAMENTO ':' : CA.'9E�2 - - <br /> Cf CAJQ10511.ra <br /> Faality5 Phohei <br /> 9b.U,S.DOT Description(including Proper Shipping Name,Hazard Class,ID Nr mbar, 10.Containers 11.Total 12.Unit 13.Waste Codes; <br /> 1 Hfi1 and Padang Group(d any)) <br /> v_ _.. No. Type ti Quae' . WWoL <br /> 1 h(Q, �R A NAZI NOUS IASTE, LIC 10 G 134 <br /> t-AWEGU • FART.9 NAGH R 5`1WTi•0Uj <br /> M <br /> Z . 2. <br /> T. <br /> SpeaalHandlinglnstnictionsandAddr6onatlnformatlon 1S[I:ISM $4-usl'��`$$ .• E$12014sqQZ07 MP:21 <br /> ' - r. <br /> y Ek1ERa�E#��Yt3ft4#� + �8�175Q—G i190`4F.1�tv;�rttrar='l: re z:hef9 6f� c�p�te ecfrt rs af��>ic' � r,r� <br /> bn iaitiAl .triiir_paf -ter tc� add at, substi-tut additional •transpr-�,-jLn s 6n.t,�k'�'ra�r`�� <br /> �;• 15_ GENERAT.OR,SIOFFEROR'SCERTIFICATION: 1 hereby declare that the contents oftNs consignment arefidly antl_accu ately described above by�e proper shipping name,and are classified,packaged, <br /> marked apQiabele 9%plaoMed,and are in all respects in proper condition(or trenspert according to applicable intemational and national governmental regulations.If export shipment and I'am the Primary. , <br /> } Exporter I.oeFti(y jdat the contents of this.consignmenf conform to the femis of the attached EPAAbkr owledgment of Consent <br /> I certify(tlatpa tivas(e rpirpmita8gp statement identified in 40 CFR 262 27(a)(if(am a large quantity generalor)or.(b)'AI am a small quantity generator)is We. <br /> Gene Offerors Phnfe yptd,Name Signature Month Day Y9ar <br /> 18:Intemational.%phieiUls c rr--�� r <br /> I fa U.S. Q Export fog U.S. !exit <br /> Transporter sigpamfe(for exgdrts y):,. <br /> leaving EI,S:: <br /> ,W'17.TranspotterAdmbwiedgment-of-Receiptofldgteriais <br /> Trans Printdd(J aft g <br /> O DtAi6q; <br /> y Month ;Day Ye2r <br /> z Transporter 2 Rrinte8liyped Name* Sig nature + :1 ; <br /> :Month Dey .Near <br /> 18.Discrepancy' - <br /> 18a.discrepancy Indieabon Space <br /> Q Quantity 0 type El Residue ❑parpal Rajectf Full R <br /> bn ejection <br /> of <br /> Ma[nTest Reference Number. y <br /> 1186.Altemate Fadfdy(or Generator) U.S.EPA ID Number' ,p <br /> a Fad y's Phone: - <br /> W 18cSignaturenfAlfemat@Facj)ittr(orGegergtor)•�' qac Y- <br /> - <br /> C7 ,Hazardous yyaste,Kapott fylanagement Method;Codes(i.e.;codes fm.haz�rdous wa;te treatment,disposal,and recydirsgsystems) <br /> 3 [4. <br /> 20.Deslgnated'Faa iJjty�_.-or pr Operator,Cer4gca8onrof receipt of hazardqu;materials pbyered by the In Meet excep('as nded In Item 188 <br /> Nahie Slgnaldie. :Month ay Year <br /> rANICA <br /> EPi'71�• R 'i( Q 7) P.re'vious editions are obsole e. - = DESIGN4TE6FACILITY TG GENERATOR <br />