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Sep 11 2015 10:52AM HP Faxi-adds Maryna 2094779585 page 2 <br />cue SK R 41; P.4I ')1i!° <br />Please pnint or type Form designed for uss on elite 12 phch►"writer,) F91D! A ved. OMB No. 2950- <br />NPORM HAZARDOU6 , Qw0r8wJDNumber r 2. P e of 3. <br />U VYASTE I!AlIIFEST 1. , . ��w�>E 1S�k # � <br />tii r � Me� <br />NRN`A.Yi�! Ns26t ��?IQItT1lf;;j[4 ling dress) <br />IV C'Ove, Way <br />. CA 9-5491-21K-11115- <br />GeneratorsPhona: --477 ;�r"�'r•,1 SEPI I <br />6. 'tc,"Y TINS, �{ a , U.S. EPA.ID Numtrer <br />TXMW a f,r..l$'s <br />7, Trenaporler2 CompaiyName WE <br />AD Nurnber <br />uc4''rW r)co9F�T�AF�I <br />B, Designated F8c91ty Name and Site Address e9 U.S. EPAIID Nunber <br />EDON eg Phone::. <br />v' <br />99. 9b. U:S:'DOT Deecription Qndudng Proper Shipping Name, Hazard Class, D Numbs, 10. Conlaa>ere <br />HIM arid packing Packing G(If any)) 11. Total 12. Unit 13, Waste Codes <br />1 i t No.. Type, Quanbly Wt No. <br />p p 31:'.���i� �f=tf,•i�1,�!' ,ly � h�� X � �' ' i � <br />i7 <br />t . <br />4. <br />14.3pecfdl Ha � ini fr <br />uctigns and nal IMormatx>tt w <br />760 <br />tisk 7 TIw' t <br />MW <br />" OP4" BY GFPCER TOR TO 'TAIN k,.TCFA9E�1'WRY, <br />15. t3ENERATgR'$fCFFEROIYS CERTIFICATION: 1 hereby de,iara that the contents of tMs wnsignmerrt are fd y and acourelely deeoribed shove by the proper ShlPping Hama r ora dessitied, packaged; <br />'t ga,d and atieledpfacarded ertd ere in all respects Ihprteser condhbn for6anspat according to applicable iManaearel and national govemmerdal regrAature. If export shipment entl I errr the Pranary <br />Exporter, l cart f) sial thecoritenis of ails cont gnment confirm b the farms of the aftachr�d IPAAcknow�d06rrt of Consent' <br />I oertiy that'ihe waste mhYn'[zaAon statenxerit iderrdfled In 40 CFR 26127(8 j (e I em a Iar� quarrtlly genelnibd) or (b) Of Ism a snail quantify generator) s true) <br />r ' s Primedliyped Name a,ru <br />Month Day Year <br />J <br />18. Intemauon fe, <br />❑ I mportW U S. ❑ aport k. U.S. 0+ . f nntrylex,t: <br />Transporter signature (for exports only): Deb leaving US.: <br />17 lYansW.bsr Adtnbwiedgment of Recelpt of Materials <br />�. Treneport 11 slgn,re <br />Month 'Day Yea - <br />TwwPwtw rP?w Name. r S� Monthd <br />Day Year. <br />18: Diacxepancy . <br />Spites.:,❑ Ihra'rratytype ❑Reeidue ❑PaAelRejedlon ❑FulfRe*tlon <br />Manbel Refers w Number. <br />1t3b.AHamateF •,, (crc�enerab(j U.&EPA IDNumber <br />Facilgs Phone: ' <br />�' Bp.91gna9rreo1gltemate edldy or neyator). +. <br />44 onel Day Year <br />1a Hazardous Waste Report Management Method Codes (i.e., codes at hat, ardouniwaeEa tresinart, dLsposet and. cycling sy . ms <br />20, Designaled Facility Own era Operator: Cedificdw of receipt of hazardous metarells covered by the mardlestexcept as rood In-lWn lea <br />Pr <br />dlTypa ams tft <br />WiF Day Year <br />EPPpPp7n Q,R y�� editiions are obsolete. GENERATOR'S INITIAL COPY <br />--, <br />