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• <br />• <br />• <br />gni nr tame- fYDrm desk far tse an ellle l72 aitchi tvaewrifar? <br />Fo.m Aooroved. 0ME No. 2050-0039 <br />lziK FRrrrs BTM-22{CiEv 3 pyo prey mea edilian5 a e a so a - - <br />DESIGNATED FAGIL.MTO gwnNATION STATE (IF REQUIRED) <br />MCIF@#tM HAZARDOUS <br />1. Ganeraler IC Nusher <br />2. Page 1 of <br />1 E-,aerggFxy RespBnse Fianna <br />d ((eyyst Trackism lumbar ,+� <br />1154714 G B F <br />WASTE MANIFI i <br />U Od0182& fi <br />i <br />74d 7445 ,' <br />V <br />>. Generators `ameand Mal 5rgAddress Generators Site Address (if different thea mail:rtg address) <br />PREMER RN1sRNG <br />79 40-S LfRGE ST- <br />STOMON,CA 052M { <br />Goneraiors Phone:�$-��. 1 <br />6. Trrsporer 1 CI>Impamy Name U.5. EPA ID tti onbef <br />SHOP WARM SOLI-nONS,INC CMDOM6497 <br />7, Trenspmrtar2 ConFmy name U.S. EPAO Number <br />8Des gma:ed Faci6 y Mame and Sri AddressGB&�� U.S. FPA ID Hamper <br />11855 WHTE RFK RD.. CADMIM103 " <br />RN"O CORDOVA, CA 95742. <br />M-351-om .. <br />Facr�hePtane. <br />5a <br />9t U.€. DOT Da alptfon (inclerg Proper 5M.ppmg Name• Hazard Cass, ID I lh nher, <br />10. Coma r e s <br />11. inial <br />12.'uro <br />13. Wage Cadzs <br />Na. <br />Type <br />Hkl <br />arad PzddDg Gmup [d aryj) <br />tluarA} <br />m Yd. <br />t , N.D.M. 5. <br />1, <br />FW3 <br />2f <br />°C <br />0 <br />(ACETOW.PANT) (00DIPfi ) <br />zM3077, EFURORMEWA17 FPZMDM SLOSTANCES. SOUD, 9, <br />1 <br />DM- - <br />325. <br />P <br />DMITPGM <br />{ OMR# (M07) <br />3. <br />4. <br />i <br />14. SpeaA Hanil&q Idshixti s and Addftal Inkmeafran <br />9b04'R ALE 45Q5 (*.ACET ,,PAINT 1 iLTER AX <br />ZWZPROFI E 791�1I€.; DFIED.PW&' �kTE&L��t FiOMul;ERGA171. <br />APPPOPRATE RROTECTM 4:LOTHNO.,, lF <br />i5. GE4ERATUR'SiOffERM'S C€12TIRCATIONr I hereby dedete that the cmteris of ihie eansigmnent are bid and ac&ratalydesoe ed atave byihe pnrpersno ft.9 name, and are dassiixd, packaged, <br />raatkeQdad la5sieftlocarded. and are in all respeclsin Fmper mn0jen farlranspmrt accort`m to epplinfasntemaNndland national gar rnmardal reguaftm tf owrt -*psaent and Ian, 6te Prmary <br />Exparter, I certifylha'the valents of the cansigiment conform to the terms of fire attached EKAknuMedgment ar Ecrssent <br />I Dartitf the[ the waste maticNnafior. Matamani idatdfred fn 46 CFk 26227(al (d t am a late quanttly genarafrxl or {bj PM am a small quan6ly generator) is we, <br />Gemarstoftfl)fsr'sFia�adr7ypedNam Signature Month Day Year <br />t <br />1 <br />t6• IrternatonalShipments <br />4ltpat U.S. ElEmort iron U.S. PtxtaF ambyreafL _ <br />— <br />Transporter slgnemve (hos expans oNyX Date IeaNng U.s.: <br />LW <br />17.Transpoler.4r�k mleigmentomecmtdMatcrials <br />FL, <br />Trampwtt rinwYpeduame Moth Day r <br />CL <br />J (/ T F� <br />Transporfer2Piirtedfi,peft N Sig Mnnit Da}. year <br />M <br />19 Gls+h?par� <br />r— <br />49a. Ciserepmrcy ttMication Space <br />❑ tlaueiity ❑Tye ❑R�3tt f, s?asSalRejec6an i<_iFU7;cejec5nn <br />Manifest P.eferance Numtsr. <br />ate.. <br />'$b. A,tamata Fa.ai!y (cr GSmea.ar) U.S. E.°AID NrtmGer <br />-t <br />C <br />Fec�ltys Phone: <br />Ud <br />w <br />iSc.Sourtm axgernateFac+liiJarG?neratur� k4owh Day 'fear <br />G <br />z <br />512 <br />.9. l9Mrdoth AFasM RepoC Mgracem:, N: <br />e e hgd G,�des fm.. odes for hazardixe; waste freamt, Dispesa4, and n .yeting systems) <br />Lu <br />2L+.17 Sic ra ed F3ci€y CWner or Operator, CrificaW5 of rete pt of huatdws malMals 00veied by lite manifest MMI as ncf?d in l 183 <br />I <br />PrSmcatT4••yerf Namta G, <br />..�gr%altm 1fanth Dar. Ya2r <br />117 1<7 1 11) <br />lziK FRrrrs BTM-22{CiEv 3 pyo prey mea edilian5 a e a so a - - <br />DESIGNATED FAGIL.MTO gwnNATION STATE (IF REQUIRED) <br />