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Please print or type. (Form de.;ignad for use on elite (12 -pitch) <br />\s/ <br />7. Gererelar lD Number P id 9. Ems Number vvorvu cvau-uuos <br />UNIFORM HAZARDOUS - .; age Emergency Response Phone 1. Manifest racking NumRba <br />r <br />I WASTE MANIFEST _ C 0 :.= 6 5. 6 8 ''iJ —`-6.5.4''- �� f' }� i /j 1 i� j� JJ K <br />I` <br />}r <br />- 5. Generatota Name and Mala Ptldress <br />n9 (iemreefa SHeAatlress (H different than mailing address) <br />n v_ _ <br />Generators Phone ': f-ii32� <br />6. Transporter 1 Company Name U.S. EPA ID Numhm <br />7 Transporter 2 Company Name U.S. EPA ID Number <br />B. De ignaled Fedety, Name and Sm Address U.S. EPA ID Number <br />Feat s Phone ....,,.�.. 'L-. A i ft e U R <br />90- <br />9b. U.S. DOT Description (inducing Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers71. <br />Total <br />12, Unit <br />HM <br />and Packing Group (H any)) <br />Quantity <br />WWyol, <br />13. Waste Codes; <br />No. <br />Type <br />0 <br />1. -.. - _^P^ <br />— <br />a <br />FOR REMLINIGMEATMENTS AT SHE <br />T <br />DeMENNO / KERDOON FACILITYIN COMRNj <br />_ <br />t <br />3. CALIFORNIA. THIS FACILITY HAS THE Nff <br />- - <br />' <br />PERMITS TO RECEIVE YOUR WASTE VREAM A <br />{ -- - <br />1. Special Handing lnalruccone and Addmpnal Information <br />crx[umu C` <br />.; frof, i'K yidl, 7r1.«E 9 titl.vI1LSAU_-EC:f#•, <br />24 M?t Et EVs;EftiCY CGRTACT- Ha) 3F:'J: CRc <br />15, GENERATOR•SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described ahova by me Propershippirg name, ab era classified, packaged, <br />marked and labeled' placarded, and are in all respects in proper condition for transport according to appfcable Miami national governmental regulations, If export shipment 0-MIemthe Primary <br />Exporter, certify mat ace contents of this consignment conform to me tenors of me attached EPAAUmoxledgmentof Consent. <br />I artily that the aasle minimization statement identified in /0 CFR 262.27(0-) (H I am a large quantity ganam or) or (b) (HI am a small quantity generator) is true. <br />Gen IraW/s'Oiferols PmteNTyped Si aNre Day Year <br />-' g • —Month <br />= � y t'- 0- i /0 i'T ) " <br />.' •i _ .ice ��–_— <br />J <br />i <br />1:. <br />16. Intemational5hipmenis ` <br />❑import to U.S. ❑Export from U.S. Pon <br />— <br />ofW*exit <br />Transporter sgni (for exports only): Date leaving U.S.: <br />17. TranyprerAdPpvledgment of Receipt of Matedes — --� <br />cc <br />arti` <br />Trentpoper i PrinledlTryM '— —_— <br />Y SignaW <br />: ' `K\' '-';,_/ 1. ` Cis#--=-._� _-':''- ------_xf-- .' - Monera Day Year <br />z <br />q <br />Transporter PnnteQRypad Name SignaWre <br />� <br />mom Day Year <br />Iti <br />78. Discrei <br />Its. Discrepancy Indication Space ❑ Quantity ❑T YPe ❑ Residue ❑Partial Rejection ❑Full <br />Rejection <br />Reference Numbertar) <br />186. Alternate Facility (or Generator) <br />J <br />U.S. EPA ID Number <br />U <br />LL <br />Faaftys Phone: _.... <br />w <br />16C. Signature afAltemate Facility (or Generator) <br />Moth Day Year <br />Z <br />p10. <br />H�yz'ardous Waste Report Management Method Codes (Le., codes for hazardous waste treatment, disposal, and rung systems) <br />2. 3. <br />20. Designated Facility Owner or Operator CgNflatlon of receipt of hazardous materials covered by Be manifest except as naed te Hem 18a. q <br />None SigneNra ' <br />- .., I: Monm Day Year <br />y%' 0�' - <br />=P <br />Form 700-22IRav 3.n51 Prougamc <br />DE f - .-.....: <br />