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.-��� �k1 ,: � �: -:� . '�:.�.. a�,,.. . -.���, µy. z -��y' - . :�''' . , �3'TSC- {�.� �-.tii-'�'�•�5'� ... <br /> .` r. <br /> W <br /> Please print or,. teed T s -'' ;J` t :' A Fam Approved.OMB No.205(-=9 <br /> ort' des tar use ori'elite{12-pitrlr)rypr#wrdeF) , <br /> UNIFORM HAZARDOUS 1:Generator ID Number f 2.!19 1 of 3. Response Phone 0. Tracking Number <br /> WA$TE tI MIRST :' C A 0..9 8 -2' 5 0 8 2 5 1 , 9O9489-5W7 00321,4613 . JJV' <br /> 5.Gerteratoes Name&nd MaMV Address' GerneratoPs Sita Address(d dr mnt than maRng address) <br /> fww Western Grads U.W.G. <br /> Ate:Pat G+l; emwty,5200.5hena Street t990 Pk=w Rd. _ <br /> Commerce.CA- 90040 .. Stoddart CA 955215 <br /> 'Generators Phone: <br /> &Transporter 1 Company Name U.S.EPA ID Number <br /> Htaz Mat Trans, Inc. 'C A T�0 8 0 0'1 2'8 0 0 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number . , <br /> 8.OesignatEtd Facility Name and Site Address U.S.EPA ID Number. <br /> SNM MflS Weter Teo 151- ogles COtp. <br /> 5375.S"BoyIM AW' .' <br /> Velr>Ich CA 90458. . <br /> F sPhoni a 'CA "D 0 9 7 0 3 0 0'9 3 <br /> ga 9b.U.S.DOT DesmVion Cmdurtng Raper&hipping Name,Hated Clam,ID NuMberr. 10.Containers 11.Tout 12 Una <br /> 13-Waste Godes <br /> NM and Radcfng Grorp(d anry)) . No. TM. Quantify Vdit. <br /> 1' Non-RCRA,Hazardous Waste Sol 352 . <br /> oil ©M �� P. <br /> z . 2 <br /> Itl - . .. .. ...- . <br /> i 3' <br /> T 4.. <br /> r <br /> 14.Special Hark"Insbuctions andAddilional 4dormation . <br /> 9b..: /di eget/dirt/s3iaorbent Profile ".P1.654078" <br /> GI.ave s' 6'Ga9gles <br /> 15. GENERAiOltVOFFEROR'S.• ,TION:I hereby declare that the contems of this consignment am fury and aca rategr desadbed above by the proper shkong name,and are fid,pec od, <br /> marked and fabelWoa��k fid ae in respects I propff condflon for transport a000rdlhg to Wicahle intematipnal and naltvna!gavemrrrenla6 negntatfons.,ff expel shipment and I am the Primary; <br /> 4 F orte,I ceAi[y tllat the cadenl3'of this conslgmnani oonfam to the'Iemre of the atlaahad EPA AdarmMadgment of Corssent <br /> I cartHy that the waste minirdtatlon.slateinent idantlfled I n 4O CFR 282.27(e)(W I am a large quarrtlly generator)or(b)I I em a small grian*generator)is true. <br /> Geheraw# y0ed Name Slgnaese Month Day .Year <br /> P .. ,�. pe <br /> J W 1 Slapmerrts. 0 7(polf from US. : Pat of erntryhudt <br /> h- ,.' El lmpgdoous E <br /> Z Transporter Signature tfor awns only): : Date teavbng 11.5.: <br /> M.TrarispalerAddwrvtedgmentof Poo*of Meteriab41. <br /> ' <br /> caTrenWl / , Sig ce Mfln1R Day� r <br /> OlUM <br /> Tramporter2 Priawnypsd Signature Month Day .., Year <br /> I&Discrepancy <br /> lfia olsaepanny brdfcatlmn spare: • .❑Qty,' ' Q Type Residua OPaAla1 Reteoticn ❑Ful ReJecAon <br /> ` - MwRW Reference Number <br /> I&Alternate FedGgr(or Generator). U.S.EPAID Number <br /> Fedi"Phone w <br /> ttic Signaboa oFAltemate Facft(a Germramr) 7 on ..Year <br /> H19.Hazardous Wasla Report h+brnagentent Method Codes(.e..-Wes for hazardous waste treatment,disposal,and rung systems) <br /> 4• <br /> I 20. Fadkty 2gr or Operator Ce*katbn matedab covered br tca manHesl etmepl as Item 18a Y / - • . <br /> r Stere / MonthDaY Year <br /> I � <br /> ' T <br /> tO <br /> Ap <br />