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�Q�� • • <br /> ,l F <br /> (qbRECEIVED MAY 0 6 2014 <br /> chaste print or type.(Form designed ror use on e0te 72-pitch)rypewMerJ / <br /> 6d <br /> UNIF MHAZARDOUS tGenerata lD,Nym¢erf / t Fon Approved,OMB No.2050.003 <br /> 2.Page i a! 3 Emergenry Response phone 4Manifest Tracking Number <br /> WASTE MANIFEST q,s7 _ S 011805671 JJ K <br /> S.Generatfs Nam eaM Mailing Atldress e'{T`" 'n_ .' 7 <br /> Genealors Ste Address(HtliRerenl than mailing adtlmss) <br /> Slefis rllOSnlCa1 Cnry'JTa,SEnl; <br /> 2302 Lartin Circle Siena('&-ncw <br /> Geco1010Industrial Dl <br /> ratofs Phone: ,$_ S NV�N9rt31 7?5-;i--'iS'41 R1+s C <br /> e,Transpaterl Company Name "ria ('' G5 <br /> U.S.EPA ID Number <br /> world Envimture0ta!&.Erxr F().Bac 2 T6 Vrest S Dr - tr,.C 9569 <br /> 7 TrenspoNer2 Company Name ('� -•+n. <br /> U S.EPAID Number <br /> - 8.Designated Facility Nems and Ste Address - <br /> 6,EPAiD Number .. .. . .- _. . <br /> Reccdogy Hay Road -r <br /> 6426 Hay Road <br /> Facet s Phane: ?07-4513276 Vuxvi IQ,CA 956g^ <br /> go, 9b.U.S.DOT Description(including Pr CADG 71 <br /> g aper Shipping Name,Hazard Gass,ID Number, 10.Conteiners <br /> HM :and Packing Group(if any)) 11.Total 12.Unit 13.Waste Codes <br /> 1, No. Type Duandty Wl.Nol. <br /> K <br /> R.C.,NA2212,ASBESTOS;9.PGII1 <br /> w - 2. <br /> 3 <br /> 4 e <br /> 14S at Handling lnsNati \ntl Atlditiorral lsrtisrmaa'on , <br /> y <br /> PA RCOCn IX BAAQMD,939 Ellis Skvd <br /> "ahFrawliseu,CA 94109,(415)771-6660..ASbeSt0X Rena Va RegVIM u1t <br /> 40CFP,61.(B e!ed sealed label, <br /> 75. GENERATOR'SIOFFEROR'S CERTIFICATION:Ihe2by dedare that the contents of this consignment are fulty and accurmetydescribed above by the proper shipping name,aril are dasstled packaged <br /> marked and sbeleNplaceNed,end are In all respect in proper cordmon for transport according to sppkmde iniornatlonal and natoml governments] <br /> Exporter,I cerdfy thatlm contents of this consignment conform to the teens of the attached EPAAcknovaedgmamofConsent. g reguleh'ons.Nerpert shpmentandlem the pranery <br /> I cen*that the waste mmimtratbn statement identified in 40 CFR 262.27md(11 am a large quantity generator)or(b)(61 am a small cont <br /> Generatofsl0iferoes Rimm 7l'yped Name-� 9 HY generetor)is true. <br /> le � SgneWm_,,.r�� <br /> rend /'�S..y... r 7t�' Monty Day Year <br /> �, i6.Intemalmnal Sh'rymeni II--II y Zj Cw <br /> � LJ lmpotl to U.S. ❑Erpod from U.S. +. Port ofentrybod, <br /> Tmnspader signature(for e9orts only). <br /> w 17.Tmaporter veadgment ofRemipt rfMaledals Date leaving U.S.: <br /> K Transported /AbectT am/e Signatra ty �_yy ga <br /> O A <br /> " ly N/— l r t�j `•�' a' ' '4 CL j ( r <br /> G Tmnsporter2 PnntNTyped Name Signature <br /> r Monti Day Year <br /> 18 Otcrepancy �—� <br /> 188.Disempancy Indimgon Spam ❑ Quantity QTYPa Residu ... . .- ..- . .. <br /> ❑ e ❑Patiel Rejection EJ FO Rejection <br /> 181a.Altomet Fadlity to,Generator) Manitsl Reference Number: <br /> —s U.S.EPA ID Number <br /> U <br /> W4 Facility's Phone: <br /> F18c.Sigratum ofAlmmam Facility(or GenereWr) <br /> Month Day Year <br /> H19.Hazardous Waste Report Management Method Codes(i.,,codes for hazardous waste treatment,disposal,and recycling systems) <br /> n f. <br /> 20.Desigraled FactCvineror Opera Cadificedafrecelpt of rdous materials Cowden by the manifest except asn tlin Item l0a <br /> Panted yped Name <br /> ,< 19nalura, „(, MoX Day Year <br /> EPA Form 8700-22(Rev.3-O5) Previous eamons are obsolete. — F <br /> DESIGNATED FACILITY TO GENERATOR <br />