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r� <br /> PW*pdnt or .(Form designed for ,EI' ,(12rpitrh)ty Forth Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Genehatar ID Number 2.Page 1 of 3.Emergency Response Phone 4. }'�u e <br /> WASTE MANIFEST GALi1.D 3Q74ZCl 7. i;1 U.LJInU >�77 JJK <br /> 5.Generators Name and MailingAddress Generators Site Address('ddifierem than mailing address) <br /> TRUM REIAFR WO <br /> K" '. <br /> R AVE CA <br /> CA MW <br /> Generators Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> AWRY. 09MNlE#tM Q A D 0 2@ 2 Z Z V V 0 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8,D,�l a U.S.EPA ID Number <br /> `LOS ANGELES CA W(k* CA0097030893 <br /> Facli' s Phone: (3231277-1900 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Pacldrg Group(if any)) No. Type Quantity W Wd. <br /> y YSY DM1 UA9A Dcoute YMlve 4M IR Mit vent bit`s <br /> A..z.r. <br /> rwswawawswr wt Vw a* a aUww ev46.1 wMswaf "7 <br /> DM P <br /> z 2. <br /> Lu <br /> t7 <br /> 3. <br /> i <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> EmERGEmw omACT CHEMM0 i400424*=NAERG#Wl.271 *PftOFRE i 881=122143 ORY SMM <br /> *PO#AU0198060 a AMOMAT£FINOWL POTEC E ROWMENT > 5 l <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accumbay described above by the proper shipping risme,and are classified,pectiaged, <br /> marked and labelecilplaramed,and are in all respects in proper condltlon for transport according to applicable International and national governmental regulations.If export shipment and I all the Primary <br /> Exporter,I certdy that the con of this consignment conform to Me terns of the attached EPAAdmlowledgment of Consent. <br /> I cemly Mat Me waste minim' on statement identified In 40 CFR 262.27(a)(If i am a large quantity generator)or(b)Pf I am a small quantity generator)Is true. <br /> Gen8raMsrs Pdned7fyped Name Signature Month <br /> DayYear Year <br /> ^ , <br /> , } / • ' rr / : r1 _ t <br /> F 16.Imematlonal Shipments ❑Import ta U.S. <br /> ❑Exportfrom U.S. Port of enhylexil: <br /> = Transporter signature(for exports only): Date leaving U.S.: <br /> 17 TrensporierAcknowledgment of Receipt M Materials _ <br /> F" Tre r1 Pfinlo Signature „•+^ T Day Year <br /> T�ramporter 2 Printed/typed Name Signature ' Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Fug Rejection <br /> Manifest Referecoe Number. <br /> '1St.Afiemata Facility(or Generator) U.S.EPA ID Number <br /> U <br /> LL Factiiys Phone: <br /> Ow 18c.Signature ofA6emate Faal4(or Generator) Month Day Year <br /> z <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,codes for harardeus waste treatment disposal,and recycling systems) <br /> LU 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Itam 18a <br /> 1Pdooi7R Name Signature 1001h Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />