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�!T7Fv!'! es�ebg T <br /> SHIPW ' / — <br /> t <br /> ;iii <br /> " Please pr"nl or(¢pe, ;` - : : Forrp Ap rgved.OMB No,205b-6039gIr ' <br /> UNIFORM HAZARD U5 >i.Gen�fator ID Number,. 2.Pa 10( ol(, ns R 4. a e re i J r' 1 <br /> WASTE MANIFStY' 2�' c <br /> Qnerato 0 irhe ti d;, ailing Addre Gane}atora vile Address(if different than(nailing address) . <br /> -ScafaTt r. m ,• r•. rands,Inc, <br /> �9 `. ttchenr.y+ r3 , <br /> •U�nera�tao�rs�Pr`h�ane' �m . <br /> 6?�" t"t r Ty by l e6i'�iT M'B Imc U.S.EPA IDNuOW, <br /> 7.TranspQiCer2 CLmaL�N U.S.FSA ID Number <br /> Neslgmgd,FidIl1yNameandSileAddregs SAFETY—KI SY TEt1W, tVG, 'U.S.EPA ID Number <br /> 6000 88TH STREET <br /> t^ <br /> SACRAMENTO . , CA 95822 <br /> Fo6f s Phone:' <br /> ffb�U;S.DOTDdgS Aptlon Qncluding P.mperShipping Name,HaYard Crass;ID Number, 10.Containers 13.Was Codes. <br /> 11.Total 12.Unfl <br /> IiM' P�crdng C7Jo44tip.Sd anjgJ• - <br /> No. Type Quantity. WWol. <br /> . O '. a I3L4 <br /> o <br /> 4`140't JEC) PARia �:S :SIjER SOWTIUN)' <br /> Sped a]Handling.lnstructlonsa afon x� � i 51204 20 14' a <br /> ?. <br /> c 4Nt1£ 91±11r#81DQ �lfi8--lliH�51�ITX--Cbntrac "rt� InstY Ety generator. calner� age>Ysf� ;a�a8prit <br /> fan' att,a �;3Z transptricer $r� add t7�', .pub titute adds li n.al ''�baospur rs .opt g.r�aei'a%4r'.S- cue. : <br /> 15: GENERA70R'SIOFFEROrjIS CERTIFICATION: I hereby declare thatthe c6nteirtgs of this consignint�it are(elf-aqd accurately described above by.W proper.shippirig name,and are classified,packaged,' <br /> marketl and label edlplacartledi cund.are In all respects in proper conditioia forfrdnsport according to appli`abfeintemational and national governmental regulations.If expodshipment and I'am the Primary:-. <br /> a : Expoft I c,O"ai p mutants of this consignment conform to the tahps of tie afached EPA Ackr�oyyledgmen[gfConsenl <br /> I,certify jFi�t-f Jawasle minim1ragon statement identified in 40 CFR 262;27(a)(if I'agr a large quant ly mere rW(b)[rf I am a small quantity generator)Is Eve. <br /> ' enerrrtor?lgferol'SAnntedlType Name Signa ie._ <br /> Month Def Year. <br /> 14 <br /> ¢ 'F IrrlporttoU.S OFatfromD Port ofentt�lexit <br /> Trans0.r ii slgrlaiufe,[f4'exports ctl�} Date leaving U. <br /> $.: <br /> w 1T.3m terAclSf"d4Wadgmen{`ofd2e�alpfAfhrat pals 4 - W,7777 <br /> ,pi. L. yi: <br /> a T n5poilAr 1 EnPIedJTy .�Jaltte a 4 r , Si9pa Monlb Day. Year . <br /> a <br /> z 7ransporter2_ Ated/Typeb Name` 41 lure d x' <br /> M. , \ anth ,Day -,Year <br /> - <br /> 18a fuxep;r ey'Ir,*:,g.,Spa9811Quantity TYtre ResiduaParOal <br /> Rejection 0 Full Ref <br /> S f. r .✓ _ , <br /> Manifest Reference Number: <br /> X41 fafnaleFaeiy far enerdraa� _ �.-_..� ,,; y _r i,,� — mac- c ,re coA? blertiE r <br /> _�•,- r_. a.+ Q. •�-�tv�_-•,R• K�4:� �- <br /> e .. <br /> w 180.Signature of Altemaje-Fadlffy(cur Ge'meretor) Month Day Year <br /> pus Wesle Report Mana ernkMethod Code's I.e.,codes for hordalswast§geatmen dis sal,'and re I� . Gems <br /> P s ( k .v� yyd�9 Sys ) <br /> 2. <br /> 20Vh DesinaWodlity 0ym�ror bpei�3�7n:�eilifigahgn 0(tfAce)pl 6Ghazetrlous-materfel✓;Cd6eTetl dy die el,.�t eZaplas noted in ltem.1 , <br /> �� 4. ^ Slgnatu <br /> Month, t)ey Year <br /> E�>FIo � i1�).Previoti>}editions are obsolete; :• ©ESI fiED FACILITY TO CE;J :ATOR <br />