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Pleas print or type.(Four+designed for t 112-pitch)typewriter.) Form Approved.OMti Na 205.103E <br /> + UNIFORM HAZARDOUS i GereT _. 2..Page t of 3.Erna gac.y Response Phone a Manifest Tracking Number <br /> WASTE MANIFEST -4 JJK <br /> Name and MaiingAddreas Geneal.Vs Site Adarew pt different than madmg address) <br /> 17 <br /> Generators Phone: C. <br /> e.Tanspona?Company Name U.S.EPAID Ncmoa: <br /> T T.ansoenCompany er2 npany Ni PEG 0 8 9A U.S.EPA ID Numbs: <br /> 1 s roved Facility Nam and Site Address ENVIRONMENTAL HEALTH U.S.EPA ID Number <br /> DEPARTMENT <br /> Fa6li 's Phpne: <br /> ga eo.U.S.007 Descdphon;i.o!uong Prope.,Shipping Names wazard Claw,ID Norlaw 70.Containers ?t.Tow 12.Unit <br /> p,M aro Padtvg Grana(If any}} No. Type Quantity Wt.htpl. 13.vtasu Ce:<as <br /> K <br /> UM Hp,BEEN UUAUFIE0 <br /> ui <br /> a z FOR RENCUN6(I <br /> A ilk. <br /> RcAT .t <br /> QeMENNO I KER"a fAC{LiZ1'ITRE MPT <br /> _ <br /> ' CALIF iNi " Irl" REAM Fk�b <br /> FERI%Igs iu RECEi'YE YOUR WAS'CA G8OO1?352 __- <br /> n REPANUMBER <br /> ta,sa dat Handling batnzdons and Additional Information <br /> 15, OENERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare that the contents of dais consignment are hay and accuatety Cescrleed above by the Proper shipping name,and am dassiaed,pauagiii <br /> :narked and labetedialararced,and are in all respects in proper condition fortranspor,according to applicable intemadonaland national governments!recuiwons If ezppn sSdpment arrJ I am roe Primary <br /> ExDovm,,I ceni'y Iha;„he wnten's of this consignment conform W the terms of she adadred EPAAWowNdgment of Consent. <br /> Icardty that the wows mlramiza6cn statement identfied in 40 CFR 232.27(al(tl I am a large gaanbtygwre r)or(b)jiff am a smell q-uwn.ly genemlor'r is we. <br /> Ganeretrry08erors FnnaedAyped N;arca cigny^,z= Monro 04 Year <br /> J iS.lnfema4enar Stdpmerds I— <br /> 2 Glmpan is C.S. ❑Eaport from G.S. Pcnd MitrytieDk <br /> Tanaponer s"gneNre lfa exp::19 a,dyj: Data leaving U.S: <br /> w 17 TmnsDc AdmovAedgmantdRecepto(Maten;'s <br /> I Tanssonse I Primee<Typed Name Signature Month 08V Year <br /> 0 . <br /> o. <br /> n <br /> Q Tanspertv2P Metl%�yoad Nacre signature Morrt ' , "ear <br /> C <br /> r <br /> t&.Discro;ancy <br /> 7£e.C soepency Indicaroc Space <br /> Ouanoty F„l Residix ❑Panel Rejacoon ❑Fug Rai.s. <br /> Manifest Reference Number <br /> 18's Ammam Fspfily tar Generamri 113.EPA IDti=bw <br /> J <br /> L <br /> Fadutys Photo: ... <br /> W 18e.Sgg sjreefAaemate Faauty(cr GG.araiorl Month Day Year <br /> 6 <br /> 2 <br /> 19.Kwardoss Yvaste Repot Management Memod Codes(c,cures for hazardous.waste treatment,disposal,and recydinn sys=-rat <br /> 3. <br /> I <br /> i <br /> I� 20 Desow dFacSryOrmsrorOperatorCargfrzaonofreceiptofharardousmatenNscovazdbythemanr'estecoep:asrdsdini;em?So <br /> FdmedTyped Name . 5grabim,' 0-, yea' <br /> DPA Fon 5700-22 fRev.3-05) Previ0U<_editors ere obsolete. ` _ 7 Y Tfl GENERATOR <br />