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PlsaetpmR artype.(Form designed for mean elite(12-pitch) ewriter) <br /> UNIFORM HAZARl1OUS 1GefQre�-ID Number Form Approved.OMB N°.2050-0039 <br /> WASTE MANIFEST - 2' ¢1°f H.Ernergenq Response Phone 4.M��anpyifers't Taeking Number <br /> �, Ld'� '$ <br /> 5 Generator's Name and Malling Address �.. � :, €. ! / CI C <br /> GenSwIluchan1wwala's StleAddress(ddiHwant than mailing SCUMS) t {—LG <br /> 01hdmffiw aj�ft <br /> CA 9L <br /> ,m+ns�parterl C}om 7�9�e,1sti��- <br /> s'daa+W++ea�+asRJOA T{ ) wv} U.S.EPA ID Number <br /> 7.Trenspodw2Company Namemsrraa <br /> • U.S EPA ID Number �w++�nl1Vd <br /> y. <br /> 6.Designated duty Name end SimAddmas <br /> U.S.EPA ID Numberam 11&ism S •)1 <br /> .,� <br /> Fadlily'sP riew .Vr <br /> itom <br /> ga gb.U.S.DOT Gastropod,(mdutling Pmper Shipping Name,Hazard Class,ID Numher, <br /> HM and Padung Group(ganyy 10.Conlaners 11.Toml 12,Unit <br /> No. Type Quanti13.Waste Cotler <br /> O ty Wt.Nol <br /> Sas <br /> w2INU2-RCRAHa2ml aur WabW. CW <br /> X {UN3�ACK,rxnaC C. <br /> PG GonralY�Eiy�dd q pg <br /> 74.Special Handling Ins W coons and Addltbnal Inf°mallon E <br /> Plr od hkWlb v "S bndtnMr{M DTt}6{75 <br /> 7} '�.•.�.Bl{_. ori � �.•_„� <br /> 'ENEA <br /> heo <br /> 15. marks aTOR'&OFFEROR'SDnd am <br /> res chin proper <br /> ewnitmg Of this consignment are tally and aceur-----scdbed above by the proper shipping name,and are dassifred,packaged <br /> markedand Wb the <br /> eeowe and re inall respec61n proper ruMdion for transport according to applicable inlematlooal and nail governmental regulators If export shipment and am the Primary <br /> I Isoder,I certify Nat Neawlents afhlsmnsignm otmMwm to the terms of me sdadtad EPAAcknomedgm¢nt of Consent. <br /> Generator <br /> that the waste minimization alatement itlent'dled In 40 CFR262.27(a)(iflam a large quantity penerotor)or(b)(ifl amasmall quanfity -----r)is lme. <br /> Gerrerelor mr's Pnntedr7yped Name <br /> "I i Igre re <br /> 9klam <br /> Inle <br /> J 1fi. mone <br /> atl Shiptip ments .r�`I ��?/i"l.-^'✓ i ii'sr <br /> ❑Impon to US. 4=# <br /> Trans der si mwm for an aso ❑ESpod from U.S. Pon ofemoy/exit_ <br /> w 17.Tratrcppdergdvnw{edgmenld ReceiplMMalerials <br /> Oow leaving U.S.: --�— <br /> ¢ Tarter, soled d Name " <br /> gf� on <br /> ransc <br /> r ° e I n, <br /> Q TportePnnted?ypetl Name / ��" tp!{,rAYnikl.� . f - <br /> Fy. neNre <br /> Do ay veer <br /> 1 16 Discrepancy <br /> I fee Discmpancy Indiaryon Space ❑Quantity ❑Type <br /> ❑R°ad°° ❑Partial RejecAm . ❑Full Rejsmlon <br /> 106 Atkmata Facility for Gerwa Manifest Reference Number. <br /> J <br /> � U.9 EPA IO Number <br /> Q <br /> f+- Fa" 's Phone. - <br /> 18C Sfgi ofAflemala Fadlity iw Generetor) <br /> tD - Month Day Year <br /> N19.Hazardous Waste Report Management Method Godes(i.e,Willa.forha>ardoas west¢treatment dlsPoral, d re <br /> . and ms <br /> ng system <br /> ) _ <br /> 3. <br /> 1 20.Designated Fav Dmrer or � t <br /> htY Operator.Cero(tafgn of reda'pl of hazerdo.........s rgvwetl by the maninatexcept as in item 76e <br /> PdniedlTyped Name <br /> { }, SlgnaWre � <br /> 1,' L 1I jf r f, -,; I..I jI3 . Mumh paY Year <br /> PA Form 8700.22 <br /> 1111v 3 5) "ensues editions are obsolete. <br /> DESIGNATED FACILITY TO GENERATOR <br />