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Dlnnen n.:n1 n. h,nn IJZ . A.,; —A f-- nn nnln 117_n11..1.1 M1,nn..,nlnr 1 a \ Form Aooroved OMB Na. 2050-0039 tf A rarRt bfuu,ez (ttev. a -u:)) rrevluus auwuna — u-1-tv. UNIFORM HAZARDOUS V 1. Generator ID Numbar 2. Pape 1 of3. Emetgemcy, Response Plane Number 4. eni00802.5056llesst Tracking FLE WASTE MANIFEST C`ALIM103=7$ 1 149&7-7225 S.Generators Name an I ng Address Generators SiteArldresS (if different than mailing address) T l.9*L1cs CBA Stfail Logi uce LLC .4190 CL Atte: M11iMtf1neike punnaer SWI13MM CA 9W Generators Phone: ZaBi 6. Transporter 1 ompany ame U S. EPA ID Number Fiiliiianwd Chemiael Til h -ii (SV) CARD0007OW 7. Transporter 2 Company Name U S. EPA ID Number 8. Designated Pamlity, N�ame�and Site Address U.S. EPA ID Number reatffleird 6133 E*h Blvd W. T NMS? �ow07 UVI li hone: 30- Fads P 8a. 9b. U.S. DOT Description (induding Proper Shipping Name, Hazard Class, ID Number, 10. Ccntainers 11. Total 12. Unit 13 Waste Codes No. Type HM and Packing Group (if any)) Quantity WUvol. 'Nco;W-RA Hivill waaeSCM foly 1a) rM r rw�1�rA r h \f y..Iy M vi�.�.j, ` !!! �' •.. ^^ tr 3:�'L' kt.•liH ^i"+:::1-'..L'�Z-� �.rJ1'1`;"f r- 'x:�-Z.;_� }.�Z;:: t+. -j � � �.L',� — - 4, i 14. Specel Handling InMotons and Additional Informadcn PMI@dx �OiCl/1!FSI'Q If:W3462 i� W* ACTSIM IRA i J__��x. '~�. Ic 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and Iabeledlpiacarded. and are in all respects in proper condition for transport according to applicable intemational and national governmental regulabens. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the teens of the attached EPAAcknowledgment of Corsenl. I certify that the waste minimization statement identified In 40 CFR 26227(a) (if I am a large quantity generator) or (b) (if I am a small quantity geru;raO) is true. Generator rots nnIecV7yped N Signature �r. '; Y Ym J 16.IntemaC nal hipmenls ❑ Import to U.S. ❑ Export from U.S. Podof an xit: i si nature for ex only): Date leavi U.S.: w -Transporter 17. Transporter Acknowledgment of Receipt of MaWals Transporter 1 PrintedlTyped Name Signature Day aer Z ranspoder 2 Prinfed/Type a gnalure Y r oc H 18. Discrepancy _ 18s, Discrepancy Indication Spacef ❑ Quantity ❑Type ❑Residue ❑ParGelReJeGlionrl-�'`Fegrr zbew■ 1.-a: Manifest Reference Number: 18b. Alternate Facility (of Generator) U.S. EPA ID Num E P 0 S 2015 J_ V Facifi s Phoma: W 18c. Signature of Allemate facility (or Generator) `, yw Q Z N19. Hazardous Waste Report Management Method Codes (ie., codes for hazardous waste treatment, disposal, and recycling systems) 20. Designated Facility Owner or Operator. Caltificalion of receiplof he materials covered by the manifest except as noted in Hem 18e Pn edrryped Name Signature .// f � I Y88< tf A rarRt bfuu,ez (ttev. a -u:)) rrevluus auwuna — u-1-tv.