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• <br />0 0 <br />Please ON or type- (Form designed for use or. 61p {12-p tch; tipewr1ler.) <br />a <br />C <br />13 <br />n <br />U <br />2 <br />U <br />G <br />FormADDroved OMB No. 2050-MI9 <br />ffUN�IFOIRTIIMI }fAiARDOUS <br />SIE AUiNWEST <br />1. GantvaW, ID Ntvrber <br />Cx.00019M <br />2. Page 1 of <br />, <br />3. Emergency Response Phohe <br />804T A-74�P <br />sf Tratirl Numt*r <br />Md1. 4553 G B F <br />5. G2.r&.—v 's Namo and taoalbrlg Address <br />PR�R:FlM <br />7�i0& 1.�F1�•$T: <br />FtT<"TON, CA "M <br />Ganeralpr's Phare: <br />Gmemtprs SM Addtass (9 dater it than mairatg address) <br />6_ TransporteriCt>rnpanyName <br />� r <br />U1, EPA 9DNurrlher <br />CADDIDIDN"07 <br />7. Transporter 2 Cc nparq Name <br />U.S. EPAID Monter <br />8. Designated Faaity Name, and Re Address <br />SVA. LLG. <br />l ta66IMNTzfK= ill. <br />RANCHO COMMA. CA W742 <br />Fedi Phone: 914.36/-9m <br />U.S. EPA 10 Number <br />CADIggM193 <br />9a <br />9L. U.S. DOT DesUlp9w Cre0ing Proper ShOp ,Noma, tiaxad Gess, ID t�lumber, <br />andPoekirgGmup(rfany)) <br />t0. Cnnlakless <br />11. Total <br />Qpaniity <br />12. Ulfl <br />YJI.Not <br />13. W3sle codesRiht <br />Ha. <br />Type <br />i <br />; <br />F6RZAi�DQtRB iAL F 5C3i1D, lI.O Fiti 91, Nr�V3077. R <br />(fMO t(>&M) <br />j 2 <br />dJ <br />0M <br />TW <br />P <br />D007 <br />131 <br />L <br />2. <br />3 <br />d. <br />14. SpecialIiWndEnglistricb mandA4c4"IlnlNTr8 l <br />Z� "TE "E <br />15. GENERATORWFFMORS CE.t#11FICATIDN: I hereby declare &! Hie wntertSof this consignnwd art- My rand ac r.Wy desvibed above bylhe proper sW9phq,; me" ad am dsas5ve, p staged. <br />maa*ad and Iatevfdrlaarded, and are ie a1! respects In pmw condWn for ftwspart aaco,ding ha ePa Pe intarr,a naland nafbnat p -v mental rogtlations. Nexperi shipmuntsW i am lht Prrnary <br />Exporier. t av% rl tthis cmWft d this conagrmmnl wn%xm to the tarms of Vie aftm d EPAAdTcW dgmeni Of OTMent <br />I cwfrN ftt the waste "Kmtaadon stalamarg idendad In 40 CFR 252.27(a) (ii I am a Marge quanTy panera°tor) Of (b) (dl am a snw:i quarb;y ganerea?r) Is true. <br />GeneratoralCffaroYsPritladlT Name Signs �` —ti Munth ()By Y <br />.I 1'o.lntatnatbr l&ipmenis �fr1w,to l.& L.JErpo,tom US. Portoferbylexlt <br />Transparearsgnahae(fareaprtsanlq}: ieavhugU.S.: <br />� 17. Trarreparinr At#ma�tedgrnani W Rece.�i 7f NWaBriala -. <br />7r2nsuorAer E PrntadJi'yp�dName Sigaaturauonth Day Yr <br />OL <br />rn Vmth Da,+ Y - <br />< <br />Q T,-ar_�partar2PrlrtL+drl4p?dNama rStgnahere <br />r I I <br />r&. DisQeparwy <br />158. Discrepancy Ind[alion Space C�2r1P.c ❑TF, Q Resldm L ?atffal Rejcdion n RA Rao'-tiev, <br />Wnifasl Refnrwres Number_ <br />igb. Atir,"te F2al4v (w Genw^ater) U.S. EPA ID Number <br />V <br />FaaT*,✓s Pham: <br />18c. S"tu re of A1tnnila a FaciW tor C-ece.2tori u mi Day <br />G <br />z <br />F21.ig046urdol5 4lao Report Wriageman! Atefhpd C4*s fe- codas for hazardous waste"a lment, 4mmwl. and It cychng syeen s) <br />W��Designated Fsdity O,vrrerar Oparoloc Der fcatbrtof recdpt of hazardous malertals covered by Els mWesi ezrapt as nded is Item 183 <br />Pnnlrbf#yp00tvarne�`�`%j Sgnelure 4 M v' <br />EPA Form 570D-22 (Rev. M51 PreVim edrfiorls are vb5olete <br />