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Please printf or te. Forrn dnign'd.for'use on lite 12•pitch.rpeu,ritec ;7 Form Approved,OMB No,2050,0039 <br /> UNIFORM HAZARDOUS IrGenerebr 16 i umber 2.Page 1'of' 3.Emargency Response Phone 4.Manifest Tracking Nbmher <br /> (� �[ <br /> WASTE MANIFEST kala - �7 1 7 1i7Q30 JJK <br /> S,Generators Name and Mailing Addras, Site A ( di t <br /> 314 -j�C k�+� <br /> STOGMN,CA 950-2 JUL J 0 2014 <br /> Gererato sPhar 7^i_- <br /> 6.TransporterCompany Name U.S.E?A ID;�urnber <br /> RAMOS E iRCY-Sl4EMTAL iB:C_ �qC►d�r3�5� <br /> 7.Trensp ,a ?Company Nama <br /> '' DEPARTMENT � - <br /> 6,Designated Facility Name and Site Addr9aa U.S.EPA ID Num* i <br /> r f1F1C t'?E r�3t�R�� <br /> - so���TPIGO B,L tom. <br /> U S JSJGEiES,CA W02i <br /> Facll s Phone:�• -714�a <br /> I <br /> ga. 5b.U.S.DOTDecrnption(including Prop sNppitlg Flame.Hazard Class,ID Number,drin1l).Containers 11.Total 12.Unit 13.Waste Ccdes <br /> I'M and Peg Group(it shy)) No 7 pe Quantity Wt.lVol. <br /> 1 J�{!1 3,tArp iIps,3,>•C;if CFI DIM G 33 Dwi r M18 <br /> _J:2 <br /> LULU 1 <br /> L <br /> t:1 r <br /> 4. <br /> I � t <br /> 14.Special Handling Instus ardAddaamIon <br /> � IG95-1)PROFILE.+ <br /> >, a` �, <br /> E,R. CONTRACTOR: RAWIS El1V1RCAiu1EA4T,al_ <br /> K4.N0LER$. HOULD SE'TCtAIN D AND USE APPROVED PPF <br /> 15. GENERATOR'sforrEROR'9 CERTIFICATI : I hereby declare Thal the contents of this consignment se Fully and accurate:y desalbe atwva by the proper shipang name]and are classified,packaged, <br /> marked and labeledfplecsrcW,and are in all r SPeM in proper condition for transport aCCording to appricsble international and national gcvemrTrantal regulations.If export shrprnenl and I am the Prlrrwry <br /> Exporter.I certify that the contents of this cons gnment Conform to the terms of the attached EPA Acknowledgment of Consent. <br /> "'ttertifj`Ihat 1M3 w$�te rninkhl�aiion statement dantified In 40 CrR 2g2,27fa){H f am a!are uanti er.erato or 0.Sri am b;mall.uaMit� ehar to true. <br /> Gane ratoes7Offeroes Prtnted,'Typed Name Signature —Day Ran <br /> 1 04 <br /> nx <br /> 16.In matidnal Shlonw,s <br /> F E impori to U.S. Export from U,S. Purl of entry/exit <br /> Transporter signature(far exports only): Date leaving U.S.: <br /> 17.Transprn�erAcknnwlsdgmentofReceipt ofMateJs <br /> Transpofter1 Printed/Type arra ) Signature r" ttr, � Month Day Year <br /> a Trartspo r p Name $Igna ff' M2njK e r <br /> 98.Dlecrepancy <br /> 1Ba.Discrepancylncication SpacEl e <br /> Quani El ❑Typo aeskiee I�El <br /> Partial Rejeetlon l ❑Pull Rejection <br /> Manifest Reference Nombr,, <br /> 18b.Alternate FaallIty(or Gerierato') U.S:EPA ID Number I <br /> ..r <br /> to I <br /> ud Fsclity's Phone; <br /> W 1$.3lgnature Rilgrnate Facility(or Generetor! Month Day Year <br /> 19.Hazardous Waate Report Management Method Codes(i.a.,codes for hazardous Waste treatment,disposal,end recycl;ng:xystcros) <br /> p 4. <br /> 24,Designated Facil ty Owner or Operator4,t , of receipt of hazerdeua mate ale covered by the ntanifed excerpts~Its a <br /> nma ypsdNamer SlQrature Mrmth Day ear _ <br /> 11 '1 aClI) <br /> SPA Form 8700 22(Rev.3-05) Previous editions aha obsolate. DESIGNATED FACILITY TO GENERATOR <br />