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i <br /> : 7." - ,fit'_ :•a. <br /> '` 5-IL,'k 7 .-ri?':.' s.'-f'•..xY" _ .4p. yb- '�S "_•-:..T r: _ t p-�'cr- <br /> M <br /> Please printoi.lype-(Formdesl neCfor,uge•onelite:lForm Approved.OMB No;2050-0039 <br /> ' UHIfORM HAL4Rt)QI3$: <br /> I.Generator ID Number - 1 2.Page 1 of 3.Errrergenry Rasp—?h�a 4 ManHeatTracking NOrn <br /> WASTE MANIFEST': : C A•D B_ 8 2 .'5' 0: 8,2 5 1" 1. 909-88x5847 - ::0 0 3 214 614' JJ K - <br /> 5.Generators Nam atld MabV Address GeneraWs SbAddress{O dthrent Oran rnaling address} <br /> VrOed Westem Grooes's. : U.W.G: <br /> AM:Pett GUNWMty.3240%elle Street. .' 19W Poco!Rd <br /> C.orrm> CA"94040 . : ; Stoddon CA.95215 " <br /> Generaws Plwae:: ;3 2 3 --2' 6 4 5 2 0 4. . <br /> S.Transporter 1 Company Nama U.S.EPA ID Number <br /> Haz Mat Trans, Inc.,, '" C AJ 0. 8. 0 0 1 1-8 0' 0 . <br /> 7:Transporter 2 Gompany Name U.S.EPAtO Number ' <br /> 8.Designated F30ft Name and Site Address U.S.EPA ID Number <br /> 1$30 W. 171h71h Street r <br /> ON 8eaCh CA.90813 �y` <br /> FaO esPtine:'."W2-'432-54A6 ` '- C A D- 0 2 8 4. 0 9 b+ 1 9 <br /> ga. 9b.U.S.RIOT DescripOon pnduding Pm. W Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.UnO 13.Waste Codes <br /> HM end Pacldr?9P(d anyf1 No. Type .. Quantic) WUVOI. <br /> VNi.OW,Waste Aerosow ,_ AM 343 331 <br /> 0 2.1_. I " i <br /> f DM P. 1 <br /> i <br /> r`: ��'�S h ^' 'L OS it'h'OYF�Tnv•y c'SUB�SSl� CO <br /> ~ pRGY Or <br /> r �rbtu?.tr� TORS�Gse � opr° Sp�.4� ►� arst►i�r�lers�t .. <br /> sk.R�lrr4 GAAP M,fCAI.4Rt y[ECpvk'RY A.O GN <br /> LOtNSERYATt17N <br /> _CGU.. u¢i.S»_.. ....._..........._ _.-• .... _ _, _...--- -- -"-r-� ------- — — -- <br /> _ <br /> .14. and Addnal tnfomtation `, <br /> 9b.'-:I. :raersols•.- 'Pro€i'le:#:'51192 1.)e 5!r : . _Glovea.b Goggles <br /> 15. GENERATOR'SIO MOWS CERMFICOON:I hereo)declare ttrat the,contents of Ods consignment are tiny and acarately described above by the proper shlpptng name.and are classified-padmged, <br /> "mertred Arid IaDebdlplacardad- d`aro in adre§pects In <br /> proper catlOcri for trerisport aowrdlrg to;.appecable irdematfor2l arrd.riational govenunetirdl regulations.if wort shiprneid^andl am the Pnrr®ry. <br /> `-" Eupafar„I'rsrdy diet dm:oohterds o1 this consignment canfam to the lama of Ora stfaached EPAAdOwrvledgmeet o1 Consent.. <br /> r ” :I cerOfy thal tfia vrarile ntlritniizatlotl statainent]denfrfled m 4ttCFR 2tiT YT(a}(M I,em:a large 4!�d►S!generator)dr(b)[dl:am;a smau quanfNy 81 is true •'-, ';� r :, .r ; <br /> Oe s Name r ,r { Signatures : Month»r�` � <br /> "�. _-�„c s.}" 3� ;�, t, �z � ?. 4}.s3,a'�'i3. ✓k %rtL ^. - ' - - <br /> 1 a •. <br /> r ❑Import m U.9 0 Export firm V.S.- Port of enbyleudC <br /> VTiarrapartar signature(for ea�orb onhr}; Date Iseft U.S: <br /> 1T:Tren poftAckr*W$QmentctROWOofMatedele' <br /> T 1 PAn 1 Name-r Month Year <br /> TranspoRer yped Name'.' &igne4ns Morldt Day.: Year <br /> .. - F. - <br /> ;z <br /> 18a Dlsaepemy MQketian Space, ❑QuY O Type., ' ❑ e ❑Pwtlal lteJedlari '• ❑Full Relearn <br /> iu�st Reference Number. <br /> 18b.Alternate Facility(or Generators : U.S.EPA ID Number <br /> Faa"Plwnec s <br /> v <br /> - � 18c. adPOy arGeroera�r} ... ". "•� � - Montlt Day Year; <br /> � '19.t•Ieta'rAdrs 1NaSfe R iirent Codes 1.e.codes'ibt lraxardous.wasta:treatrnen d ,sal and ms :. . <br /> 1: 2 3 4. <br /> 20.Dec d Fa"Owner or Operamr:Certilira .al of materials covered by the wccapt 18a <br /> F rnn )ped NameryMp�� DYear <br /> EPA Form 870022{Rev.3 )5} Previous aditio are obsolete ` (DESIGNATED FACILITY TO GENERATOR. .. <br /> i <br />