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s <br /> Pleaie print W type,(Farm designed for use on atilt 12-ptdl)NP Form Approved.OMB No.2050.0039 <br /> NIFORM HAZARDOUS1.Dominator ID Number ZPage D 3.Emergency Response Phone 4. T ng Number <br /> WASTE MANIFEST G A d 0 0 0 2 8 0 7 6 8 1 500.424.9300 1016465030 JJ K <br /> 5.Generator's Name gAddress Generators Site Address(tdifferent than mailing address) <br /> SsAvraylrt+:k: Safsrwy Fuel 02707 <br /> $ftssen�bn CA 94M m"mak 4Nw S�kMn CCA 9 PUNC=7 <br /> Generetors Pthaw: 9rk2 5 4 6 7 - 3 0 0 0 <br /> 8,Transporter 1 Company Name U.S.EPA ID Number <br /> ErrAmaneftl Logisks. Inc. IC A R 0 0 0 2 1 7 5 1 3 <br /> 7.Transporter 2 Company Name - 1 U.S.EPA ID Number <br /> B.Cast sled Facility Name and Site Address U.S.EPA ID Number <br /> Cast said! <br /> Ssrvkas,III <br /> 190,W. 71MaMe venw <br /> Obwohgbn CA 92316 <br /> FacieysPhone: 909 421-2012 IC A D 9 8 2 4 4 4 4 8 1 <br /> 9a. '9b.US.DOT Description including Proper Shipping Name,Harard Class,ID Number, 10.Container 11.Total 12.UnitHM and Packnig Group(tmry)) No. Type DUanMy WUMI. 13.Waste Codas <br /> 11 W IS.Sill cod flint Aronpwble Yquld.n.02.49Wdnsh <br /> > <br /> o r� 4.1.PQ11 352 <br /> '; 1�/rl /0'e <br /> z a <br /> w <br /> c� <br /> 3. <br /> 414. , <br /> Special andInstructions and Additianal Information t kS�O�IDN/N�q�FbN:.llO�d�s<,FUN BrU11WA"-11091417 EROgi33 <br /> A1AGR1Y69ABbt <br /> /x .s r <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the conlents of this consignment are and accurately described,lkmve by the proper shipping name,and are diseases,packaged, <br /> marked and cubeledfp acarded,and are in all respects in proper condition fortram port according to applicable International and national grnemmenfal regulations,If export shipment and I am the Primary <br /> Exporter,I coNfy tlatthe coments of this consignment conform to the terms of the attached EPAAcknowledgment of Cannot- _ <br /> I car ity that that waste mkdmiretiom statement klentiried In 40 CFR 262.27(a)(t I am a large quantity generator)or(b),(i6tein a small quantity generator)is hue. <br /> CeQmrators101feroes Prbbdrr Name I i Signature `..... Monro Day Year <br /> '�-- � `I .�. <br /> —11 8.lmamawmi nnipmem ahan U.S. Pod ofen aril <br /> F ❑Impwtto U.S. Export trill <br /> = Transporter signature(for exportsoray): Dabbaving,U.S. . <br /> W 17.TranspaterACWhowtedgmud of Receipt of Materials <br /> Trans PdnladlTyped me Sig MonIt <br /> g ' O �i . <br /> QranspDmer Mill Nam Signature Month Day year, <br /> 18.Discrepancy <br /> j 18a.Discrepancy Indication Space 0 <br /> � ING SERVI� RIA e�cpR ❑Po to Rejection ❑Full Re;e,kr <br /> FILTER RE HAS THE APPROPRIA7—PEE3[�����rr�� <br /> I9£n0eterence N r <br /> 18b.AJlemate Fadll a U.S.FPA ID Number <br /> AND WILL ACC - - <br /> LL Fadliy+s Phone: •. - . <br /> w 18c Stimulate oWtemate Facility(or Generator Month Day Year <br /> Q <br /> 19.Hazardous ace Repair Management Metal Codes(.e.,codes for hazardous waste treatment,changes,and=voting systems) <br /> c 1 1 2. 3. 4 <br /> 20.Designated Facility Owner or Operator Cefifcalion of receipt of hazer ous mmenals covered by the man iie sept as noted em 18a ^ <br /> 1 rime y <br /> EPAFor n 870M(Rev.3-05) Previous ed tons am obsolete. i DESIGNATED FACILITY TO GENERA R <br />