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'.P lease pdht"Pa..(Farm.desigf star usa on allle(12-pitch)typewriter,) Form ApproveGeOMB'No_2050-0039 <br /> UNIFORM HAZARDOUS 1.Gengralof 10 Number 2.Page l of 3.Emergency Response Phone 4.fdanifeal Tracking Number <br /> WASTE MANIFEST- C'9lX� �' P 208721-2038 100481'874^' JJ K . <br /> &GenerakyA Na eand MaNngAddtess Generators SlleAddrm(if different than mating address) .s <br /> SAFEMTAY,INC. SAFE WAV#2707,844b N. PACIFIC AVE. <br /> ARCADIA.CA 91007 <br /> 81U t ANDA AVE STOCItTON,CA 95.207 <br /> DIA. ' <br /> Generators Phone: 92S-22(I.5097-290 '•�;, <br /> 6.Transporter i Company Name U.S.EPAID Number <br /> ENVIRONMENTAL LOGISTICS,INC CARCIOD172478 <br /> 7.Tfansparer2 Company Name U.S.EPAID Number <br /> e.Da4 �tr4e i <br /> ,ES.INC. U.S.EPA ID Number <br /> 180 W.MONTE AVE CAD982e44481 <br /> RIALTO.CA 92318 <br /> Facil sPhmx 99084'21-2012 . <br /> 9, 9b.U.S.00T DesaVan(ubuding PrperSldpping Name,Hazard Cass,ID Number, 10.Cunaimers f1.ToWl 12.UnN <br /> 13.Male Codes <br /> HMand Paddtg Group pfarry)) - � Na Type Quantity WHNd. <br /> 1. NON RASTES ID f 0M266 <br /> P 152 <br /> W �No-ry Rr_ad' �7)zRyzrX,us v,t1; i� g�w� � 1JM 3U Cz 3�'3 <br /> ry% <br /> 3. <br /> 4. <br /> 14.Spedal Handling lnsbucfmns and Additional Into;,, -t:'�`-l 1 1'c�yS <br /> P�(Ap.SOR9(/EM`C,t)hfYrWlThl•H <br /> YL/ROCARBENV9( J 0C 55) <br /> �(�2.fvPrR- V'( Cy1.S !X Sri <br /> 15. GENERA70R'SrOFFEROR'S CERTIFICATION:I herebydedwe Ihatlhe contends of this consignment are fully and accurately described above bythe proper shipping name,and are classified,packaged, <br /> marked and lebeledfplacwded,and are In al respects he proper conNgon for transport according In appllpble atemegonsland national govemmenlal regNstlona Ilexpo t shipment and I am the Prmsry <br /> Exporter,I ced'dy that the"tents of Vale consignment codommto Na terns of me attached EPAAdmowledgment of Corsenl. <br /> I cerfify that the waste minm&alion statement Identified In 49 CFR 262.27(a)(ill area Inme quentitygeneramr)or(b)[tl am a smal quangty generamrl is We <br /> fierce Pdn dDypeO /� r Signator 1 ).. j� �f month Dai. . Y <br /> 1 S.INamalk nal Shipmema ... <br /> Impatm U.s. ❑Erpod from U.S. Patofenkyfmrit'.. <br /> Transportarslgnaam(tor exports orM; Data Keying U.S_ <br /> K 17.TmrepntWrA wledgmeol al ReodplofMatedals <br /> Tratsporeri Print typedNOMS ( 1--. Slgmzlure 'l /djf Me Day, Ygps <br /> Tratspater2 .vedajped Name Signature Monro Day Year <br /> H <br /> 16.DWuep q II--II <br /> IS&Discrepancy Indication Space ❑ 0..* ❑Type ❑Residua It.l Partial Rejection E]Full Riclwr <br /> H <br /> 181b.A,lemtta Faciity(m Cmreramr) F I 1- <br /> 17 M A 1..- . .+_ 1 G IS—E . ,'J L.: <trrlG:1, t'- _S .Altl h6Li <br /> v r .MP-4?G-,.:3i HAS - h; ' ,-30 ;• ; - I 1:�I S till <br /> u Fadlity's Phone: (.it- :.a-! :.�,r:{_w WASr• .e. ., r, !: <br /> 1k Sigmakum of Alternate Fadly(or Generator) Month Day Year: <br /> 19.Hazardous Wada RepartMenagemW Method Coda(t.e.,eadesfor hezvdeus wasle treatmaM,disposal,and recycling systems) <br /> G 1. 23. 4. <br /> 20.Designated Faclity0wnerwOpemtm: rffntbno[mmiptof hazardous mataralacovered hythefeanif8danceptesndedin lteml8e <br /> Pdn ype e1 Signakae Month Day Year <br /> �-� 6' z`� 1 11 I -w 8 <br /> EPA Form 8700.22(Raw 3.05) Prevtoue i0ans are obsolete. DESIGNATED FACILITY TO GENERATOR <br /> r <br />