Laserfiche WebLink
ti <br />�J <br />Please Print or W. (Fmm designed for use en elite (12-pRch) typewriter.) �.L'GJi Form Approved. OMB No. 2D50 -W39 <br />Er- "ra 67ywzi tnev. aver rmawxxs ml=s are mwete DESIGNATED FAC%IT'Y TO DESTIMAIll" 57>,TE QF REQUIRED <br />UNfFORM HAZARDOUS 1. Geula IO NLIMb0r <br />2. Page i of <br />J. Emergency Response Phone <br />4. manNest Tmaldng Number <br />WASTE MANIFEST ""T OCC34B278 <br />:. <br />1004901782 FLE <br />S. and asp Adana neralors 'laktldre%fif ereni Ulan mai:bg addreui <br />T T r alba von ._ey Tom$ Fz Y�LiG^.6 <br />1313 Sta;XtoT, at <br />Lodi, C7s 915340 <br />Guteratota Plwne: 209 368-'8881 <br />8. rampoter, Comery Narna US, EPA ID Number <br />Advanced chemical CM0O00054C <br />7. lid^sparer'. Cmioam Name U,S. EPA IDNumber <br />gritted amt asoreas US. EPAID Number <br />AdV2aS! chiGm1C&1,. ':Sefltumnt <br />6133 $d;th BlViL NE <br />Albuq =qm, W 9*7107 <br />F smone: 505-998-4158 H"=2086V <br />ga. <br />Sb.US.ImTdesagfiar(mcbdvag PmpwStwPs'D Nazne. Fitmrtl Ckss.lOtkammr, <br />14. l.anW a <br />tt.TOW <br />12. Unit <br />iS west¢Cotler <br />No. <br />Type <br />HN <br />end Pa4tdpiirpup fdaaYll <br />9uanlity <br />'MNot <br />i. VA,f iiSOa WASTIs ASRV.'-V _S r Z t <br />pool <br />4&-:w33) <br />yzj <br />O <br />2. VjU r2& LJNSTE DA iN7 eS4A'TFO YY%?T CSiAt r <br />2a2 t) <br />( <br />1 <br />P <br />ryOp( <br />DQ <br />FW.b <br />jt <br />3I 1>6, =7 , (600 <br />prrt <br />! o <br />3M3 <br />20104 TOX-C LI(awl64, OCgAAt14 <br />&,,rr <br />or <br />� <br />� <br />331 <br />X <br />/J,V.4.(PHE,,VLPHTALFrxia) PP,4 <br />A_ UAr 291+1 r wJAST� r Agat L1&1104 LOaROS.rsC <br />/�, <br />goot <br />4m2 <br />331 <br />:}(S), '�X >uao•s <br />D <br />F <br />ta_Spda <br />y.��a}s�w�ya�ree^a�`MAdtliliaW lnlartwtron to&3 12b V) AGT'9,901 a fAi 0%s, VHA •afar c;w tS3 <br />proect <br />L'A61 3>7�. (I ASY 0/r)(hf 30 0/-r) ,:JAA-001 1412 i/A4-f &qt1 (Ix JTI ✓lA,COS" cQ4 iia? <br />A6-rT757 IxSS"IY VAA -003 W* *A IZ <br />15. GENERATOR'SIDFFEROR'SCERTIICATION: I tierehy 6adare, data tlae mnlmtts at ft mrrsttarmom are hey and atw2xiy described shove by the pgmrmppmg name, and are clablial, paouset, <br />marked alk am area ai respeCK ui proem cauGaop Nr OensPnn a[cKdng bapp6reMeinlamsUawl and naaermigrnemmanulmgubtlax. Ifel danipammtark1am NeP" <br />Expater, I carOfy Oast ane omlenls of Oft tontorm to lYR tems, of the Molved EPA Cansem <br />Icw*mat 0. waskmnamoW nslaten Ot alemfied in 40 CFR 26217(a)(ait l am a orgy quandrygenem4vl 7G am a $matip= gaaaaaot)b W¢. <br />a WVM Day year <br />I12 Zr r <br />-j <br />t& Intonartmal SNpmems ❑imp.1 to U.S. ❑Expui Iron U.S. Part of amyfeta, <br />Trarwnet sliname(fa ns ant )'. - Date ea U.$: <br />W <br />17. Transport¢! <br />et <br />m YPed Y ear <br />a <br />da.t zr tr <br />Q <br />rensporkr 2 Prmaeditypk Name grbtue eY ear <br />18. Dmpancy . <br />Ia <br />i�'t ePsa c7 `�"idw ElOuantRy ❑T'pra ❑Resgce UPatiN Repast n ❑Ful Rejocdon <br />ManRsst Relemnce Number <br />Ift AOemate FaWlry la Gwa rata U.SEPAIDNw wr <br />v <br />LL <br />F°L <br />Cl <br />iec. 5gnalura oyAderaax FacdOy,(or tk,s�alo Monty Day ...Year <br />t_ <br />a <br />2 <br />I <br />h19.Nadwd, <br />.'rv>_ste rt,—%limagement Method Codes (ia., sodms b Maarol=wast ti:z!mem.deP�.andreCyCF.ags}sle%) _. <br />w <br />t <br />2. J. <br />�irJ. ttp2kd FMaFP/OMrr: ar OpatAr; Cora6reMra of^o:;nlyi M. F:.¢rutleru ma�ria:sxverotlby b0 rtiamYaKaxuyM as ��csn::; 9e:n'8a <br />I�-P-rimRW!^ Ypc. t.,zme naNre ar . ..ai Yaar <br />Er- "ra 67ywzi tnev. aver rmawxxs ml=s are mwete DESIGNATED FAC%IT'Y TO DESTIMAIll" 57>,TE QF REQUIRED <br />