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Pease print Or type•(Form desomn use an eM(12-pitch♦typewriter.) Form Approved.OMB No.20M039 <br /> UNIFORM HAZARDOUS t'Generatr ro Number 2.Page 1 of 3.Emergency Response Phone, 4.Manifest Tracking Number ('► <br /> WASTE MANIFEST CAL000314774 1 a00A2+9300-CtiLI r"C 6 G B F <br /> S Ceneratofs Name and Mailing Address r y,. Generators,Site Address(if different than mailing address) <br /> CENTRAL-SPIRWO,NQ <br /> 11514 Doem WALY <br /> g r CKTON.CA 962W <br /> Generators Pions: 134 <br /> S Transporter 1 Company Name U.S.EPA Id Number <br /> FramoUw IEx* M WVA S�fldtlae,iia. Pnr1m1 #t 8OC}66Li;�1T� "'°, CAAO 0171017 <br /> 7.Trartsporw 2 Company Name U.S.EPA 10 Number <br /> d D%;Cg6"'tW and Site Address U.S.EPA 10 Number <br /> KJWW rias,co gmw <br /> FaDWS Phone: 641-0E4-9124 vi <br /> 91o.U.S.DOT Description(t +mg Proper Shjptang Name,Ha7drd.Crises,l0 NWnber, t P.Containers it.Total ., 12.Untl' y3:Wade Codes <br /> Far and Pxking Group(if any)) No. <br /> � Type Quantity W1Nd. <br /> I. IWO MGM haladws UA <br /> Z , <br /> 4. <br /> 14 Svecd Harx6ng inshicbons and Addibonai inlarmauon <br /> "MIDI si to be 401%tallrm am wax PPE <br /> ERG"71 <br /> S GENMATOR'"FEAOWS CERTIFICATION: I hereby deciara that the contents of this consignment are fully and accurately deschbed above by the proper shipping name,and are dassified,padcaged, <br /> Feud ad taededrplacardsd,and are to all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> E>7,ow,I cu*Mat rhe contents of this consignment conform to the terms of the attached EPA Ad=wl <br /> edgmenl of Consent. ' <br /> I cw*hr the waste mirumaotlon statement identified in 40 CFR 262.27{a)(f I am a large quantity generator)or(b)(if I am a small quantity generator)Is true. <br /> GerwaarsxA oes Psint"Typed Name 4J signature ` MonthDay <br /> lDay Year <br /> ! >3 lraer A nal Sh rnents <br /> ! ❑Import to U.S. ❑Evart!from U.S. Pdrt of enbylexit <br /> Trassporw Wature(for exports only): Dale leaving U.S.: <br /> j.iii 17-Trar spprler Aducow ledgm ent of Receipt of Materals <br /> Cr T-aepuricr f Pmoedrfyped Name Signature Month Day Year <br /> Q. <br /> �iA,� l�as�� 18107 <br /> Z -msporter 2 Pmto&Typed Nate S'gnaluna Mons Dry Year <br /> ,3 Discrepancy <br /> Ma.Dsaepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 16b.Alternate Facirdy(or Generator) U.S.EPA ID Number <br /> U <br /> U� Facws Phone: <br /> t8c Sglawro of Alternate Facility{or Generawr) Montle Day Year <br /> Q <br /> Z <br /> 19..Hazardous Waste Report Management Metltod Codes(Le.,codes for hazardous waste treatment,disposal,and"ding systems) <br /> A t l 1 2. 3. 4. <br /> 20.Designated Faddy Omw or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pmtedrfyyed Namey Y <br /> EPA Form 9700.22(Rev.3-05) Previous editions are obsolete. <br /> Tris ugh aTCnMl~%ram <br />