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FortnApproved. OMB No. 2050-0039 <br />Please print x type. (Form des nerd for use on elite (12 tch) typewriter•) 2 Page 1 of 3. Emergency Response Phone 4. est racking Number <br />UNIFORM HAZARd0U5 i Ganeraror ID Number t fii31 4?d 93£20 n n; n a Ari' JJ K <br />WASTE MANIKST C _¢ b f3 2 >3 2 <br />Bene l Vt-wiTMx <br />P0 BOX x CIA 9FA <br />GenemforsPhone: .� <br />& Taosporter 1 Comp�ry Name <br />ASBURY EWIf1•(?MA!'1T& -SEAWE <br />-iGM WRjjj Acom"c1�'l2 <br />Fadlltys Ph o 93O '71 <br />M CA 9b. U.S. DOT Desaoon (hc Alnq Proper Shipping Nam, Hazard Class, N Number. <br />aa, <br />HM and Paddng Group (d arryd) s <br />1� RCt CAWMDWS WASE, L€ D PLY WATM <br />G;;;—t&sSm Address (A differert han <br />1521 CWT M- WAY <br />aTom" <br />nA <br />3. EPA ID Number <br />C A 0 0 2 3 2 7 1 0 3 5 <br />AT090 b ]:3302 <br />10. Containers 11. Total 12. Urdt 13. Wasle Codes <br />Na. Type rluardiry WtJN <br />T-7— <br />MMR. <br />THIS WASTE STREAM HAS BEEN QUALIFIED <br />ENT <br />3. DeMENNO(KERDOON FACILITY IN COMPTON, <br />CALIFORNIA. THIS FACILITY HAS THE NECESSARt <br />a. I <br />QUALIFIED OUR EPA NUMBER IS CAT080013352 <br />14, SDeCW kandng InsauCWM and AMWonal Information �tptTEt3 ` 1ii€ Al EP6 COWS . 3f" , �' APNOMM E <br />NASW gel: �, f' PR,'19LE #q8# : - <br />p6Ks 7W MTE-OTIVE EQUMEW <br />HA/rmjactf 641344AL2 Pof 1 8111 1 <br />nt ore tally ac d accurafeN des«ib11 a11 d abov11 e try he proper shilOng name. and are V.', -red, Packaged• <br />15, GENERATOR'SIOFFP_ROR'S CER1tfiCATION: I hereby dedare that the contents of this ons'rgm a nlematianaiand rretlor%W governmental regulatlons. It ergrort shipment and I am he PrimarY <br />,narked and tabektVoac rded, and are in at respects In PmPm roncYfwn for karrepan acaxEn8 applicable <br />EXpoder, ( rsrf fy Drat the wmenls d oris consi9rarent eonkem to bre leans of he a#aehed FPA Pcknowl�edeyneor h tl a small quWtKY gene"An) Is � <br />I cert fY <br />that the waste mink&a5on statement id Mad in 40 CFR 26227(a) (tl . am a large quantity gmem" <br />(} ( Mont Da <br />16, Irdemaeonar yraCtner11 U Import to U.S. <br />z Transporter signabee (for exports only) - <br />17. Trv*wter ArcV-66Pent of R-0 of !detanals <br />TransperTeri Pr*.1*V N ' <br />Z Transporter 2 Pr rypad Noma —_ <br />ce <br />F -- <br />I6. Drsc:repamY <br />16a. l; saepancT LIA-600 Space ❑ Cuamity ❑ Type <br />18b. AJlomate Faciity (or GeneraWr) <br />,J <br />U <br />u4-. FarArt f s atone: <br />W180. Signature of Anomale F.Crtny for Ceneretor) <br />F— <br />from U.S. ` Pon of enbyledl: <br />_„ Dale leaving U.S.: <br />Day <br />A <br />Day <br />0 Row,. ❑ Penal ReJ f. r J Full Rrlacson <br />f,Wndiml Reference Number. <br />1 S. EPA tip Nwnoer <br />4 <br />. ark�us'Maste Repon Adar•agem-nt tv hd Codes f.a., crAfas for ^a�rdo u .,este Seat pal. dLp�sa+, and reerceng SYs <br />t9ftatsa 61 <br />tiJ 1 <br />-I� 20. Lksgrated F.nEiy {>mter nr i;i.+aratu! Carvfxanor: o! rea;rpt rt h.rzar�=as mala^ars Yivar� by'he m�na/lur' � a< nded in � �+ ! F � <br />PnntedrTti-ped l'tffirre <br />r! <br />:F.4 r+nn 8700-12 =.Rev ,ir05! Prevrous editions are bsr�aie. <br />p <br />r� Day year <br />i <br />~� 4. <br />SM;nh Gay year <br />DESIGNATED FACILITY'S CO Y <br />