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Formp�Apoved.OMB No.2050-0039 <br /> Please print«type.(Poon designed far use on elite(12yMtE)IypaATilor.) 2.Page t of 3.EmMge fiespan58 Plane A. 7 u r <br /> O V N T V A 2 G B F <br /> 1.Generamrlp Number ,1 _ <br /> UNIFORM HAZARDOUS At UA.04U MM5 <br /> it!,M 46 <br /> WASTE MANIFEST Cxrnabfs Sae Aduesa(dallHrent Iban meAirg adbass) <br /> 5.GeneratyeName enaMigAddress <br /> 1SOL W VHARI EH WAY <br /> JT(X;KION.(%A NS217ta <br /> Geneatofs Plane: 'W'L 1 S,aUat3 U.S.EPAro Hn✓rr <br /> b.Transpoderl CanpanYName <br /> ruwwtsna <br /> AAMEHIC:AN VALLkY WAJTk:(>It.,M'II:. US.EPA ro Hander <br /> 7.Tanspater 2 company Name (:AR(101117S4� <br /> --w<aHLUNNtat HE(-'ORR:HY aYS1EA1b M'M. <br /> U.S.EPAIO Number <br /> I.De,rael Faolity Neme and Sne Ad6ds YIMAA Yk.S LL(: A.'IPfXM117Ss^-' <br /> ;NUL 13Neb1 <br /> ra)MA,ti 8536aYa <br /> FadePlaae: w16641""Jab <br /> it Shipp,Narre,Hazed Cuss.ID Nueba,, te.Cmtairers Nahttl 11 Und t3.Wass Codes <br /> 9a. 90.U9.DOT Drnvpbn lalds�9 q°Pef �� No Type Wantlry vn.Nd. <br /> HM amt'W"OpW"If) _L9: <br /> h P <br /> 1. W*,I-RCPA FtlVARf"iS WA,ttF 5L1t 11.I <br /> >AmRgPPlt PAPER OR Flf TMA t,FRRf9 <br /> i z <br /> w <br /> �a <br /> SEP 14 <br /> li.Speaal lyrdYrp Irubut'UMs tMAdabaw Infdnxem �,ll <br /> R01'It,Lr„ �:.; ; t.A.� I-Nf;At VI IA*R(*NCY L'OWAC7-(W-WO1 <br /> 15. GENEMTOR'SIOFFEROR'S CERTIFICATION. nereby tleclare mat Va contents oltivs mrsgnment are blly arM acrvmtely tlesmbed above M lba IarPper NiPpaS roma.aN are das5ifed.padaged. <br /> marred and IabeleNplaWrtled.aM are In t'respects�n proper condieon for MnspM aam'abg b appliabb ntemaamwam natronal govemmenul regwnms.N export Snigrlmt am I am 1m Pnmary <br /> Eapratc.I rehr,that the Cenlenu of mis Nnsignmenl rpnform tome terms of de atteWed EPA/rhnaAMpremd Cameht. <br /> li dty Nal Ne waste minimwtan sutemem identified ma0 CFR 2fi2 PIal�ifl amalNge nuenaTy genraamrl or(b)(a1amaaax119umlbly9enemV)1seoe. a1pnM Oay Year <br /> GeneabdsiOlfera's PdntedrFyped Name Sgnawa <br /> r'� 1 <br /> J 16.In1emarMaI 6NgMnh �Impad to LLS. LJE Whom U.S. Podofenmeet: -- <br /> � Tansparterapawre(treiaoru only): <br /> Date iev U.S.'. <br /> M 11.TraMWWAdMWWdWn dRaMOdMablreboo <br /> _- - <br /> TarSpprtr <br /> 10 <br /> Q Ta edrrped Nemo S"Jnte"fe y <br /> K 1 � <br /> H i <br /> 18.Cbveparay <br /> tea.Disoepen Inaineon Spare ❑OWWtV ❑TYPe ❑Residue ❑PrON Rejee. ❑F.I Rejection <br /> WOW Reference Number <br /> IM atemate F.Idy for(3eneralor) U.S.EPA IO Nunber <br /> J <br /> U <br /> LL Fadiry's Plane <br /> aw 1Sa 6pnawre of Plumde Fa9,Iry to Geneamrl Meath Day Year <br /> 2 <br /> 19.Hazallous Waste Rapon Marageacnt Meaaa Codes(.e.,mdutr Nmrdpus waste treatment.disposal.andrepbg syetenu) <br /> G I 2 A. <br /> 2o.DeayrutedFmllry ownerw operalu-cedir.-aranmauiMdluzardoua mortals reveres by the manaen e.reptss moa to nem tea Notice:State of California requires <br /> 1 Pimednypetl Name gnawre generator to photocopy and mail to DTSC <br /> within 30 days: <br /> EPA Form 8700.22(Rev.3-05)Prevmus editions are obsolete. p.0 Box 400,Sacramento,CA 95812-0400 <br />