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FEB/15/2016/MON 03:22 PM FAX No, P. 001/001 <br /> ksleasaludotcr We.(Famdeaigned foruse on elite(12-pitchtypewMar. Form Approved,OMS No.2050-0039 <br /> UNIFORM HA2'ARDOUS 1.Gsimralor lD Nunber 2.Papel of 3.Emarpemy Response Phone I.Manrfat TrecMng Numhcr �/ <br /> WASTEMANIFEST � 4p00 3E< �iOC1C� 1 3'It'r37fS74? �'( J4JK <br /> 6.Geraro(a's Name and MalnpAddrem Ganerat0ls SlleAedrass ltldiRervM Uan mad'np edAaes) <br /> 130 at tN Ivarwo;" st . Sluc.W ,va. , vt <br /> Genese s rana: .,Z^ Ca- Ca Vr J.- 'l C Cl, <br /> U.RaVportaf I Cbmpary Name U.S.EPA ID Number <br /> R4NOT.EANiR0WAaWAL SERMES INC. CA,g044W <br /> 7.Tran9poner2 CampanyName U.S.EPA IO"bar <br /> 0.Daslgnated Facility Name and Sitehddree3RAMO$1 ENVIRONhAVOTAL Std'ICES!NC U.S.EPA ID Number <br /> 1515 ISOlptli Rpmt RD. IasWxe+:>a vx <br /> WEST SAVRP.AAEM,.CA 95:91 <br /> FerAnya PMre9i637W47 " <br /> gq 9b.U.S.DOT Oescp*nonaiudlop Proper ShlppiV Name,Hazard Class,ID Nurnw,, 10.Conlakxrw 11.101a1 12.Unh <br /> HM oM Pakmg Gmup(eany)) No, Type Own* WUVaI. 13,Waste Codes <br /> 1, r Kal<UU U 9JR.YtC (2UA7 ;t:IL' M-%, <br /> W 2. <br /> 3. <br /> t <br /> r <br /> 4. <br /> I <br /> Eel <br /> 10.SpadMHafding Ins WOh'am aMAdditiaml IMOmmtlm <br /> �. KOHY4tiRS T,:16E j.RAJME0 AND USE'APPROVED 9 " <br /> F,R, COPITIZAFTOR' RA.tAO9 EWulRCNh1[D1T'AL SUMP— CE <br /> 16. GENERATOR'SIOFFERORTCERTIRCA'RON;Iperepy declare lhatthe wMerdv Oftlws rareignment ere fiAy end aCaxalely desMbad abwa by ga proper ehippinp rum9,arq are.ClaesMM,padaged, <br /> marked and IabekdlpWeatled,end�ih el mspads mryopermaptlgn IDr ganspOrt eccordhgto applicaae intemeti0rielend ne0alsl gOverrvneMal regukmrm.Ilaxport shgrrmnt arM I am the Pranery <br /> Expormr,Iderp' Owt Um contents oftMs aoiNgnant confbmr.to the term Alpe adsched EPAACIagMedginsrd of Consent <br /> I Csrtlfy eletthe waste mmimatim aratement Identified In 40 CPR 202.27(a)(SI am alarga quentify ganer9(0T or(p)(III alria4map qua"generator)m true. <br /> GenerAWajoRerors Ptln6d'Wjg NameC S"Wre.. Monty Day Year <br /> J 19.M1emalou 16 ❑_bnppAta U.S. ❑Export from U.S. Patoferdrylext <br /> Transporter slgnalere(IOr exports Dnly): Del&IauVn9U.$,: <br /> 17.TmmporterAdcnow'e4nertof RecelptofMale4als <br /> ons rt ennWypsd�Name $ Mre I Month Day Year <br /> �° � 4 7131 t w~iE�' 1 <br /> zd Transpader 2 P4nteafyped Narre Sitm(ere i Moth Day Yea1 <br /> tz <br /> r <br /> 1e.Dlsaepency <br /> ISa Mcnancy Indleabon Space ❑ Ouandy ❑Type DR,,'"' ❑Parrml Resection ❑Ku0mea. " <br /> Mangest Refersnw Nu nher: <br /> fi lab.Alternate Faaliy(or(3enarator) UACPAIDNMebor <br /> a <br /> " U <br /> w Fadk/s Phone: <br /> w leu signature crAgemale Faulty(or GaroMM Day Year <br /> a <br /> z <br /> N19.Hazarrbus Wale Repat Management Me7ad Ocala 04.Wdes W hamrdonwasle 6selmenl,diaposs),and mcycsng systems) <br /> 1. 2. 0. _. . 4, ... <br /> +,' 20.DaigrekdFmely ownararOpe+ala:CertlriwSpnamceiptofhemrdwa mateeay Cgyerp4 py ryla manifestexcepl ea ntlaem nem lee <br /> rye P Name ) Slgnadum /.' l Monthl� Day `m <br /> ! C <br /> 6PA FOrA1novigng elritions are obsolete. DESIGNATED FACILITY'S COPY <br />