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Pleasc;irlht or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HA74RDOIS 1 1.Generator ID Number <br /> 2.Page t of (g ngy p <br /> ;3.Erne a Res onsePhope 4.Manifest Tracking Number <br /> WASTE MANIFEST -7 <br /> 5 Generelo�s Name and Mailing Address ')95 �S <br /> k-3 Oil r f`f,•' 0",16 d- i fl Genaralor's Sita Address(if different than mailing address) <br /> E'SCALON <br /> Generator's Phone. r G 1 <br /> 6r�ranspor4er;1.CPmpanyr t?4ma�Y S TE t1S I N r U.S,EPA ID Number <br /> 7.Transporter 2 Company.Name U.S.EPA ID Number <br /> �f. f t�t� �3orZ5 ��vv cry /l.�L_ �(/(t�4 �3r3�Z�.SZ� <br /> 8.Designated Facility Name and Site Address AI- . ;-K t_! � .�)S 1 1-r1 J t U.S.EPA ID Number <br /> 6000' "rh STKtt j <br /> 916-386-4913 <br /> Facilily'sPhone: C%A0(IC}1`rq <br /> ga• 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> HM and Packing Group(if any)) it.Total 12.Unit 13,Waste Codes 3 <br /> No. Type Quantity Wt.Nol, <br /> i itlr•I t. „,H r" tJllb f<`� I L, :1 r2 'u <br /> 0 <br /> k[,Uc��S FARTS t1ASHEk .'ULUT TOW, <br /> z 2. <br /> 3. <br /> 4. <br /> 4.Special Handling Instructions andAddibonal Informal on b _ <br /> S4H "E""CYOBOO 468-1760 CH/SK/TF1-Contract retained by yeftc�rafi,nr un�ers acanct, <br /> U11 lrl'±'c`'.e1 % t}1, rt:[ULP dtldlLj.Qrroi "trar: + <br /> 7r _F-r <br /> on <br /> 15. GENERATOR'SIOFFEROR'S CERTJFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are in all respects to proper condition for transport according to applicable international and national governmental regulations.if export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowtedgment of Consent. <br /> I certify that the waste minimization statement identified In 40 CFR 262.27(a)(if I am a large quantity generator)or.•(b)lift am a small quantity generator)is true. <br /> G,erreraforsl0fferor s Pri�ntedlTyped Nam? Si re <br /> fv� � f Month <br /> —711 Day Year <br /> ,j 16.International Shipments ❑ <br /> H ❑Import to U.S. Export from U.S. Port of entrylexit: ) <br /> 9 Transporter signature(for exports only): Date leaving U,S.: <br /> LU <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> TrqnspGner I PrinledffS�Na V� S n <br /> a V Month Day Year <br /> !!^ ZztDiscreppancy <br /> PrintedrTyped Name Month Day Year <br /> _ <br /> 1I <br /> f, 18a.Discrepancy Indication Space quantity ❑Type ❑Residue <br /> ( ❑PaNal Rejection ❑Full Rejection <br /> r 186,Alternate Reference Number, <br /> ale Facility{or Generator) U.S.EPA ID Number <br /> U <br /> L Facility's Phone: <br /> W 1 Be.Signature ofAllemate Facility(or Gemalter) <br /> ZMonth Day Year <br /> 9.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal. II <br /> and recycling systems) <br /> 91143 12. 3. <br /> 4. <br /> 20.Designated Facility Owner or Operator,Certification of receipt of hazardous materials covered by the manifest except as noted In item 1 Ba I <br /> Pnnledrry, m C Sigr tuns` <br /> s! 1 <br /> 77) Previous editlans are obsolet . DESIGNATED FACILITY TO GENERATOR <br />