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Please pnni v type Farm Approved.GI,18 No 205O.W39 <br /> UNIFORM HAZARDOUS I 1 Generalor ID Kiurrw 2 Page 1 of 3.Emergency Resporse Ptx-ne 4.Manliest Tracking Number Q <br /> WASTE MANIFEST c:AL000338,..• ?I)U-734-i�,V; 1 y(�' , /1 3 <br /> GF <br /> S.Gerarato's Name and IJaiing Address Generalors S4e Addras.•(if dAereni than rrnbrq ad f <br /> i hYJliF.t�i:E Alt-i�l:t: 1 KL)LKYI+.s <br /> /41FROIHNu <br /> VRF-W'.H t:AMF' :.+A :I�231 <br /> 6.T-ansportsr 1 Company Name 1J 5 EPA ID Number <br /> ,I-W,ttK hN VAI 1.t1 WASIt (rli. !NL i; •':...'tl <br /> 7 TransporAr 2 Company firms US EPA ID Numoer <br /> IM7ftLLWti[ _M.LCIUVENY sV511ml,04rK -,ANUOOI P!i122 <br /> R Designated Facility Nene and Ste Aderam U.S EPA 10 Nurnter <br /> r i Ifut,- YI:>,:WAS L fKA"53i Lit IhAt.lt II Y J1.`R M(Yal114#1 <br /> ri5l.10 L)'j I-114)H I1AY TP <br /> Fanlrty's.Phone-✓: 344 iC43 <br /> ga gb US DOTDesuplan jrrduding Proper Shipprva Name Hazard Class,ID NtanbW, 10 Cams nets 11 T^,la! 12.unt 13 Waste Codes <br /> KM aMP*WVGmo(6")1 Ne TrJe Cuanity /A",wo <br /> 1 'a2 <br /> � fdr:ltJ Itt;ff/1 F1i\�Aft(�(111±:WASiE= ':(ll it) hfi�11lAFNT;'ti. W1I��R Coll % 11At <br /> 0 GN TFI?t;R I)VARlti � r_7111_1 <br /> r <br /> LU <br /> 2 r <br /> 3 <br /> 4 <br /> I <br /> 14.Special Handing Instrt mons andAdd:WN Ytfdnlaiton <br /> He JI f, h.N I i bbr4t*4i4,r <br /> t tV#IZtsl Mi Y t_C+JIA('1 I WIl t <br /> I5 GENERATOR'S OFFEROWS CERTIFICATION;I hereby declare tat dne cortler!ts of this cunslgrvnenl are July anu aczt aicly r:rscrbed above by vac proper shipping name,and are classified•packaged, <br /> marked and labeledTlecanded,2nd are IP all respects in proper condbon br transport a=rding to appkaGe rrlematicnal and national gaearnrnerdal regulaficns.i'export shpwl and I am the Prmary <br /> Ex¢rw I oas Ihat ft contents of.Ito Wn"nment conlnrm ID the terms of the anactred EPA Awsawitiog m of Conseil. <br /> I y that the wasps 'nYmzatan satedrsn identdtee m 40 CFR M.27(a)lif 1 am a#arge quantity generatorl or{b)?if I am a smxt quanhtp generator)is trL* <br /> C s'oul0f;Pllr 'typed Name 5+gnolurtt• - !ya <br /> i ! 17 <br /> � to fdlmaaorr� .. _ <br /> Port so U.S ❑Export Ram U.S- Pat of enlrylex:t <br /> i=ailspdrtar signstileo exporhs olt [ Date,eavirg U.S.. <br /> 1 'IranscaW Ae ,fent of Rempt of Matetrals <br /> �++ rarspartt+r 1 ype4"e / 5gnaasre Yn+ Mmrlh dfay Year <br /> Z Transpllrfer Name Signature m �y ear- <br /> le.Oiacrepancy <br /> tea Pscreparry Indralton Spat ❑ Quantity, ❑type E-I Residue ❑Pow RQj ki, Ful Rejom" <br /> Mar>aest Rolarenoe Number <br /> f� 18b Alternate Facilely(or Generaborl U.S EPA 10 N,.rnbsr <br /> _J <br /> V <br /> LL Facitgs None <br /> C, 19: Ir�naalrecAARernateFaality(crGeneralorl htadl' Dir eu <br /> �a <br /> Z <br /> i518 Hazardous Waste Repon Wragernent Method Ccdas(t o,caps for hazardous waste neairnect,r sWsnl,and rscyckng als acral <br /> o , 2 1 Notice:State of California requires <br /> generator to photocopy and mail to <br /> 20.Desgnated Facixq Onnef cr Operatc CEnificaear of recept of hazardixis rratanas covered bi the manife t exctirt as rood in Item 1 fla [)T 5 C with 31)d a yS: <br /> nted yped Name S gnezure <br /> P.() $trx aUi) <br /> 11 lA 95812 040() <br /> EPA Form 6700-22(Rev.12-11) Previous edrlions are obsoieie 5;1�r r rtl�nEo, <br /> GENERATOR'S INITIAL COPY <br />