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/7/D/(o3o'� <br /> Please print or type.)Form des n—re <br /> dtoruseonelite(12-pitch)tyl>ewdrer�11704782682 SC PPW 9/28/20i7 Form Approved.OMB No.2050-D039 <br /> 2. e1o1 3.ErrergercY ResPurse Phone 4.Na -est Tnrhin Nunber <br /> 17514 <br /> UNIFORM HAZARDOUS 1.Genaa,a lDNumber 01125465 FLE <br /> WASTE MANIFEST <br /> S.Gararetols Nave and MaairgA rens Genealols Site Address Cd den rren mating address) <br /> NNStarTwIninah:Operations Partnership LP <br /> 2941 Navy Drive SAME <br /> $[�[�0n CA 95206 <br /> Ge..re Prone:l Ill 4urrl <br /> T,7ransponerluorocaY me <br /> CleanHarbersEmirenlmendSe I usEPAIDNvmca <br /> 7.Tansporin 2 Comtany Name <br /> pC <br /> f T U3.EPA ID Kumber <br /> 6.Designated Fadiry Name and Si,Address - <br /> Clean Hwbors <br /> 2247 Sabo H Envilro 71 1ental Services.Inch N E D 9 817 2 3 513 <br /> ^vaFI(�Ie,NE 89145 <br /> go gb U.S.DOT Desorption(inciding Proper SNpirl Name,HMW Class,ID Nurl '0.No Containers 1 t.Total 12.Unit 13.Wash Codes <br /> and Packing Group ld any))and <br /> Type Quanary N1.Nd. <br /> IIIA <br /> � 1 UN3175,WAME SOLIDS CDNTAINING FLAMMABLE LIQUID. 0061 my <br /> X N.O.S..MMAHOLI,4.1.PO 11 <br /> I <br /> 3. <br /> 4. <br /> 14.Special Handling InsWclias and Akdhipnal Infomtabn <br /> 3.Ce1526a30 OCe133 �Y <br /> �i� <br /> 15. GENERATOR'SIOFFEROWSCBMFWATION: lhambyd mlom.,m msoftiswregm taruiyawd r.,eN&,teaovebyftMer na <br /> shgpYgnre'ardamdasaYred-M&A*- <br /> marked and abeiedlpaed,cardand are in all respects in proper wndbm for trenspon according to applirabla ndametions aM:atore govcnmarml regulators.If set l shipment and I am the Primary <br /> Exppler.IceNN that the come Of the wsgnmenI wnlorm to the tensdNe attached EPAAdmowde0gnenl of Consent. <br /> meatal¢true. <br /> IrxNtythat ale waste mYYmoaaon sralement cerntihed n 40 Cl 282271al ltilamalarge quantity 9er� (I lam as q 9 Y Year <br /> eat road ase <br /> g a <br /> J 16.International 'pments ❑Innen to U.S. ❑EXpon lmm U.S_ Po glen lexa: <br /> para laavi U.S.: <br /> Tres ar0ers nature for ex Will <br /> CC 17.T rAcknowladgmert ofReoaipl of Maleriak on ay r <br /> Ta 1 Pnm,tl/Typed Nacre grarJ,e <br /> QTres 2 Pdn theme �U S <br /> 18.Discrepancy <br /> 18a.Dsaepanq Indral Sl El Os'rY El Type Resiiue F1 Pallet Reject. Full Rejecton <br /> I <br /> Marled Reference Number: <br /> U.S.EPA ID Nurt6er <br /> 1eb.Marl Faliny in,Generator) <br /> J <br /> U <br /> LL Fadfi sPMne', <br /> Month Day Year <br /> 1&. gnature ofAllemate Fad9y(or Gerlembr) <br /> N19.1faaardous Wane Report Management Method Codes(I e.,codes fa recourses was,baatmem,deposal,set recycling systems) 4 <br /> a H040 <br /> 20.Designated leal Oe a Operator:CeraFaoan of recall of hemNws natarials wrered Iry me narefesl except as n ted in Item lea � Day Yea <br /> 1 VU1zzD <br /> yped ame <br /> 2(Rev. . DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> EPA Fo 23-05) revbus edl9ons are obsolete <br /> ClemHaFturc has-11a,a�T"del a MnaiN for aali Nin aecep rag <br /> the wage the Steee is chippiFtlj <br />