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12-05-12 10:47am From-D/K CU'-"'IER SERVICE <br />IB,� oirtimt3 (12•pitch tYpawri(er,) I b �+[ . 3'. <br />Ir <br />�I <br />+3105378386 T-070 P.02/02 F-508 y <br />l)N7FORM HAZARDOUS.* 'Generator ID Number `, 2 tof 3^ ns Phone 4. g Tr <br />Page Emerge Response ManttestTrackin Number <br />fit' .� <br />a <br />T r ,•�.*M..y. ,. <br />r� <br />'A <br />WASTE MANIFEST... <br />Q, <br />0 a 81 4 2 7 AR. <br />s, Gen�J d�Ma�ing Address Ganeratofs•91te Address (lf ditferem than mailing addMSS) <br />K •:; t ; ..nt <br />7�8 E STREET q -'4?7 INi>US7RIAL AVE WHNA)CESM '55 <br />�Y t <br />GenrrsroYs Phone' , k1T,,,• <br />o. Tiansponar 1 GompanyName U -S. EPA ID Number <br />iR 1 �l��1ROI~ili - lTAL SERMCES C A D C 2 6 2 <br />7 7 •'fl: 3 6 <br />7. Transporter 2 Company Name U.3, ZPA ID Number <br />B. Deaigg����ggoo acylt�N m pp��,Slt yydd�ress U.S. EPA ID Numoor <br />?11-R; jvihl{J i4 ft£Jr�Ar <br />WDA SREET s <br />COW7G' N CA 90222 C A T- 080011335 <br />2, <br />Facility's 15116110: n10)'51-7-7 1W <br />_ <br />as' <br />HM <br />9b. U.S. DOT Dasapdon (Including Proper Shipping Name, Hazard Cla:�s, ID Number, <br />apd!P &&rig Group (if any)) <br />10. Containers <br />1t, Total <br />12. Unit <br />13.'Aasto Codes <br />a <br />No. Type <br />Quantity <br />WtNol. <br />_ <br />- <br />tip] *M wASTE P)NN-T RELA ? WERIAL, 3, PG0 <br />2.• <br />.f <br />- .14. Special analing.,Instructions and Additional Information <br />^ <br />EFYURGEIl CY CONTACT: CHEMMEC 1.-EM424-M MERG# x+31: 129PROFILE # 951 > 42111 PAW THINNER, <br />FZ. M1 1,Mi-F RXNT'T PO# Af IM4684 *APPROPRIATE PERSONAL PROTEC- E EOUIP' ENT <br />15.. GENERATO TMFFEROWS CERTIFICATION: I hereby declare that The contaritS of this consignment are fully and accurately described above ay the proper shipping name, ard.are classified, packaged, <br />marked and labalWolacaraed, and are in all respects in proper condition for transport ecpording to applicable international and nallonal'govemmentaf regulations. If export altlpment and:I am Me•Pflmary <br />Exporter, I certify that <br />: the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />bcertify that the waste minimization statement IdWillied In 40 CFR'252.27(a) (If I am a large quantity genallor) or (b) (if lam aArrtall qt itlty generator) Is true. <br />Genera s/Offarors Print ped Name SI re <br />Mornh'' Day; Ywrj <br />18:Interna Ixnants <br />01m-porttaU:S. QExportfiorn Portofejl <br />y <br />Tranaponerslgnature (for exports only): <br />11: TransponerAck6owiedgmsni of.Receipt of MaterialsTrfl„• ,rr.. <br />nepoRer 1 Pr ntudiTyped Name SkUriatufC <br />Month Day,'- '?le/r, <br />1,04 <br />Transporter 2 Pr me pad yams 5�ttature <br />.� <br />Month Day' Year <br />:IS: Discrepancy N, y <br />18a. Discrepancy Indication Space ,.-I f�I <br />J Quantity LI hype ' Residue I.Partial Rejeaiun• <br />0 Full Rejection. ' <br />rt80.Altsmeae FACuny (or Generator) Manliest Reference Number.. <br />U.S. EPA 11) Number <br />Facility's Phona: <br />... - <br />18c, SignatureAltamale Faculty (or Generator) <br />Month Day • - Year, <br />19. Hazardous Wasto R�epon Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systen1s) <br />2 m 3. 4 <br />20. Deslgnated.Faclliry Owner or Operator. CMIICatlog of recaipt of hazardous ma rials coyared by the manifest except as need In Item 18a .. <br />[a YPed Nameno ilrel— ... SS <br />! <br />OnJ SY ear • <br />Form 8700-22 ( ev. 9.05) Prevlous.egflic ar o solete. . <br />�r-.21uriAr r -u rALdLI I Y IU c9ENERATOR STATI; (IF_RFOUIR ci\ <br />