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Please Print on type.(Form designed for use onlD Number elite(i2-pitch)typewdler. <br /> UNIFORM HAZARDOUS 1.Genembr 2.Page lot 3.Ercergenry Response phone a.ManHeat Trackin Approved.OMS No.20500039 <br /> WASTE MANIFEST CALp00221604 1014 4 0 0 3 4 3 JJ K <br /> i GeneralMs Name and MIFatness 80��33-8?$ <br /> Sierre Chemical Generators—,—ss(t dhkreN men malting address) <br /> 1010lidualt Df Stene Chemical <br /> Stnddanr CA95208' 1010 Nu1US111 l Dr <br /> Genembrsph.m. 2095117.7156 Smcidlon,CA95206 <br /> e.TransporRal Company Name <br /> ►t9enlum f1l�lplFasxERlWicpl►E-CuaFDcgg766-000Y - u.s.FFAIDNunbar <br /> 7.Transaction 2 Company Nam- j CAR000179747 <br /> Di7erdErniram ehI8erI U.S.EPA IDNomlrer <br /> B.Designaled Fao-ilyNama and Ste Mtlress CADB82523433 <br /> MS-AflTaar US EPA ID Number <br /> 101 811111th park Ddw <br /> 64 pleaaenkV38474 TND991920i19 <br /> I photo 931579-9642 <br /> 9, 9b.U.S DDT0estary0on(ndudmg pmpM ShpPing Nene,Hazard Class,IO NumberHM and Pacing stoop[IT any)) 70.Containers 11.Total <br /> 12.Unit t3.Waste Coors <br /> z 1' Non-RCRAHezar � Owntiry Wwol. <br /> F dour Wes1e Liquid(oilj No Type I\w s Non-RCRAHe -- i <br /> cD �rd4Hrs West Said(abaabent,ail) <br /> (meq 352 <br /> (� ._..v._�_...._ <br /> a. Nm-RCRAHamrdaus WaRie Liquid( aWftir t Rage) <br /> 291 I <br /> 4. <br /> 14.Spec al hissing(newsier,and,'Wd'nioral Infamaicn <br /> 1)ERSkAR07531 DOTER(C -/ .•< 5"SNISS mer 7656 <br /> 2)ERSNAR056]i DDTERc�tl <br /> /� 9 3)ERS#AR07644 DOTERG# 1 <br /> . <br /> 15- GENERATOR'&r0FFEp0p'S CEp7IFICATION:( Srhem dxlere al me mnlanls of tis bons' <br /> =01. <br /> arked arvJ labekNplamrded.and are Trail mspema In Ignm0M are fulyendaaurebly d0acdbad abme by171epmparshDgng name,end are dl9eeifad,PaaYaged, <br /> Eaponer,lea 8atmcemleMs 0l this proper MMllim(a0ansputemnrdagb 8POmble International and 0mlondl gmammarlml regrlalbre.Iferporl sNpment entl lam ala Pdme <br /> ' mnsignmem conform m 01 lemu of aro adarYatl EPAAdmowl¢dgment 01 COMM ry <br /> lxMyslalthee` la <br /> me of Moment Menerred m 40 CFR 262.27(a)(III am a large gtanelylenemleradl am a small tan <br /> Gene r"s;0feurs PrjntediTyped Na 1 (b7C 9 fry Generator)is true. <br /> Sg on `a� Yeer <br /> i6, ferrel one Shipments <br /> = Maotl to U,S. ❑Exeenfmm US. Port sten <br /> Tmrmpode signature(tor edpoM1S only). Mladb <br /> 41 77.TrznspsrlerpLiomsytgmm(pfR¢miP!dMalareh Data ledWn9 U.S.', <br /> WW Transit Pdnfedrryped Name <br /> O ,�� /_ 55NkaeMonth Da Yea <br /> 2 TrensPpd 2Pdn adRyped Name S7 / 'r <br /> C ig aWre ea <br /> M11pnW Day Year <br /> } 18.D'aaepanry <br /> I 18a.Dlserepanry IMimtim Space <br /> ❑ Ouandty ❑Type ❑Residue <br /> ❑PdFial Rejection ❑Full Reje6on <br /> 18b.Mhem a Fedlily for Ganerotir; Manrlesl Relererce hLmber: <br /> US.EPA ID Number <br /> U <br /> I Faefloysi Pbo e, <br /> row- iec.Signature sfAllemale'ad6ry nor Gene:afe;J <br /> 2 Month Day Year <br /> wf9.HataideU9 Waste pePal Managelnen:Method Codes(i.e,bodes for haaardous waste treatment disposal,and recycling systems) <br /> out (� <br /> 1 20 Desig aced Yadtly Owneror <br /> Pnntedrryped Name Opo otic CeNfl al on Blremrp of hazards s ma!edals overed by Poe matt e t excep!es odea in Item 18a <br /> r 'j Slgnamre <br /> Month Day Year <br /> EPA Form 870D-22(Rev.3-05) Predous editions are obsolete. Wl-?0114 <br /> DESIGNATED FAC LITYTO DESTINATION STATE(IF REQUIRED) <br />