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---.. will r, urtype. � „ Trscra�^' — -- <br /> UNIFORM HAZARDOUS 1 Ge n 7 GV1 7 L J- <br /> WASTE neraWr ID Number Phone <br /> MANIFEST L Page t or 3. Emergencyp° 77�J address) <br /> nSC1S1011 <br /> 5. GeneraMailing ,add <br /> tors Name and �LOW190682 8�' �f d tteran t in n milling <br /> P ress Generators Sile Add <br /> $ � <br /> 921 E Vii n s&�tin� <br /> Lodi , CA ��ppp7054� <br /> Generators Phone: US . EPA ID Number <br /> 6. Transporter 1 Company Name 1 i <br /> ATransporter <br /> U S. EPA ID Number (J <br /> 7. ZCompany Name SDOM inc ,DBA ACTe .nM <br /> G% eS �O u X U .S. EPA 11) Number M 3001 t <br /> 9. Designatd Facility Name and Site <br /> US <br /> 0 BORA , Inc <br /> 95. 11 Miles S Beatty 13. Waste Codes <br /> FabliVs pVe: 12. Unit <br /> 11 . Total wuVol. o0059a. 9b. U.S. DOTDesai . Containers Ouanfity 181 <br /> ption (including Proper Stripping Name, Hazard Class. ID Number. tpType <br /> 0006 <br /> HM 1 and Packing Group (N any)) No. P JF' <br /> 7 1St <br /> Q NA3077, Hazardous Waste. SoiiC, A . D. S. iLead.. <br /> C1Ell <br /> Chromium) . 9 . PGM (D008) '1 <br /> _ in <br /> UJ _ <br /> ou <br /> w <br /> z. <br /> � fin <br /> I � a <br /> Ifi <br /> 3 - 41 <br /> fir <br /> - n <br /> 4 — 31 <br /> I <br /> r <br /> 14. Special Handling InsUuctions and Additional Information Document #: �J <br /> P g r Protect Plumber 414977 '-`�41 <br /> � ' • Q7iT1FS303'17 P � _ _SfG .JrI1l51rYr�IleCsk <br /> er shipping name, and are classified , p <br /> 3ckaoed , <br /> sh <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: Thereby declare that the contents of this consignment are fully and accurately described above by the prof ipment and I am the Primary <br /> marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations- If export <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmenl of Consent. qy generator) is We . Year <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am.a small an6lyPill ) Month Day <br /> Signature J l <br /> Generator'slOf( s PHed/Typed N� <br /> 16. International Shipments ElExportfro <br /> H m U.S. Port of entrylexie <br /> ❑ Import to U.S. Date leavi U .S.: <br /> ? <br /> Transporter signature (for exports only): <br /> 11 11 111111 1 11 11 <br /> W17. Transporter Acknowledgmentf eceiptofMalerals Signature Month Day Year <br /> I— TransporterLL i:dlTyped Nae <br /> rY <br /> ✓ D ser <br /> a C I '� 6L r Signature Mo h <br /> Z Transporter 2 PHnte yped ame <br /> f- <br /> 18. Discrepancy El Type Residue ❑ Parbal Rejection Full Relectlon <br /> 18a. Discrepancy Indication Space Quantity r� <br /> Manifest Reference Number. <br /> 1 f cid U . S EPA ID Nun* r <br /> 18b Altem111 (o Generator) a - <br /> il J <br /> UIII MEN <br /> Facilily's Phone: hl `•fl1 Day \ ra <br /> W 18c. Srgnalure of Allornale Facility (or Generator) <br /> Q <br /> Z oi ! Management Method Codes (I.e. , codas for hazardous waste treatment, disposal, and recycling systems <br /> 19 Hazardous WI Roper 2 4 <br />