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C-,noraEor. l.;aii • : DTsoP.O.BOX 403Sacramsne o, Ca. _04000 Ahin30dey5.`t <br /> PIg ' bel type.(Form designed for use on elite(12-pgch)typewriter.) EES FormAp ,OMB No.205D-M <br /> UNIFORMHAZARDOUS i GeneralarlDNumber S 2.Page i of 3.Emergency Response Phone 4.Manifest Tacking2u <br /> WASTE MANIFEST Ga LCooA6bub ;' 1 <br /> L1�-�7i-1CF1W1Vp F L••lr C. 1-800-424-9300 <br /> -800-24-9300{ 010835 <br /> 07- <br /> 7 JJK <br /> S.Genereols Nameantl MaiFngAddresSrNwMIG5' nA .,'rIoNrJW2gFe_�tthan LitG6N ) - <br /> IN <br /> 1:F4 PtCE {�RrVC <br /> Furt' <br /> -`- �`TTA NT1a 5 L.U sTur_kTUN'Cra.`1 f 1.U6 <br /> Genemtors Phone: - <br /> 6.Transporter iCompany Nelle SA 1-R k( ISLE 6Pl 5YSf>6t AS I+.0 U.4_1AID Number <br /> 7.Transporter Company Name —. US.EPA ID Number <br /> S.Designated FaaTdy Name and SfteAddass U.S.EPA ID Number <br /> c11 .GREEN O1L, IidO. <br /> 6854 SMITH AVENUE <br /> N# !YARK CA 945610 CAD980837448 <br /> Facility's Phone: 510-795-44400 <br /> ga. 9b.U.S.DOT Description Qnduding P.WS1#hg N..Record Class,ID Number, ,T 10.Containers 71.Tod 12.Unit <br /> HM. ad Padcbg Grul9 Cd�Yll ! No. Type Quantity WLNuL 13,Waste Caries <br /> 0 1' NON-RCIRA HAZARDOUS WASTE, L10010 -4 i 13 <br /> i1 a <br /> 51ri <br /> 3. 's <br /> i <br /> 4. <br /> 4 ✓ <br /> I <br /> 14.Special HandlmglnsWctions ad Additional lnfoimati-o-t <br /> PROMLE� —_�.._f Q iNVOICE4' CI�flcolFl <br /> DOT ERG,' 171 WEAR PROTF-cTiVE CLOTHING SALES ORDER#MCFg1 0q <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereleydedare that the contents of this consignment are fully and accurately desa@ed above by the proper shippilg name,and are deseited,packaged. <br /> narked and labeledlplaarded,and are In al respects In propercom ition fortranspod according to applicable International and national governmental regulakns.If expert sIdpmenland l am the Prtmary <br /> Exporter,i certify that the contents of this consignmemconform to the amu of the atmched EPAAckmwleegment of Consent <br /> I certify that the waste minknizabon statement identified In 40 CFR 262.27(a)(l I am a large quandly generator)or(b)('dl am a small quaay,geramra)is We. <br /> Ge emt slO6e Month Day Year <br /> s 'nteNr Na SignaWre. M <br /> ra a /3 <br /> .� <br /> 16.tnTamational Shipments ❑Inped to U.S ❑EVorfNm U.S. Portofenby/exit <br /> Tmnapoyter signature(for exports only): Date leaving U.S: <br /> W. 17.TransporterAtlmawledgmemofRereiptofMahmals <br /> e- Tra r 1 PdnledfT Name <br /> K �v�q YPed r. Sig Monty Day Year <br /> a \O.._5y- la Pty- <br /> N <br /> 4 Transporter2 Pdnted/ryped NameSfgsehae Month Day Year <br /> 19.Discrepancy <br /> 194 Discrepancy Indication Space ElQuantity ❑Type ❑Residue ❑Partial Rejection 4.�Full Rejection <br /> Manifest Robinwroe Ntaaher: ' 1 ,, Y L. L <br /> 18b.Allemate Facrlly,(or Generator) US EPAID Number <br /> J All <br /> LL Fadlit/i Phone: - AU <br /> 2 6�pl201- <br /> G1Sc.Sgaamm of Alternate Faally(or Genemter) �-.�1VIRONM! Day Year <br /> N19.Hazardous Waste Report Management Method Codes 0a.,codes for hazardous waste habrenb d'aposal,and recycling systems) <br /> -0 1 2. 3. - - 4. <br /> 20.Designated Facility Owner or Opeator.Ceroation ofmagtofhmrdous mamdals covered by the manifest excy nded in Item 19a <br /> P typed;Nyame ,,(( p� Signa re \ \i:Mo N Day Year <br /> EPA Form 8700-22(Rev.3405)Previous editions are obsolete. D ESIG NATE P3FACI LITY TO GENERATOR <br /> J <br />