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L b W ul <br /> Cn O 01 01 <br /> O IV <br /> O O <br /> ^ Ftf1Ul15 1-Genenlw le Nu ^J D <br /> v sura raearq,yaaLUtrrlydla ~ O E3 <br /> \ O <br /> 1lIJSt AI Ifrr. a.emarcancw QQ-C- <br /> IT eomwnveaameAfW rviAhiTF�A t-AOc� UL,1)ri1V f: G°"nawr.sp.krm.•y � F d G <br /> company Name <br /> .,NN UAl_I.L-Y a'a°Rcn pinmara„I+nan a x^�c "PPrwaa � (�,) O <br /> LVA�1 "'°wM10 t w Q <br /> 'ali_IYI�.:Y isk5'yi�,IHL; (+. <br /> e.lily Name and slragaa '�t <br /> reasAi,r <br /> CI 41 <br /> Y v„Aa 1�rI <br /> IthNUI-Na r. %til�•.,r.e. uak u- cPhw •rm., W <br /> ilS-sS F� FOCIrSc� RUl�t 2VA1. <br /> alrr rrSn�A <br /> .norsa;uon pHdaalrg cep <br /> Cent'}) P'OPCr ShlppnB Nama,k :.1? US.EPAw NwnLn l';1111V1151nnM1 H• <br /> hlA IYrLI�.••\�yY!' aOara GBia.In NBmh¢r, r'✓•11�k1a1HM,a <br /> f 11F 5.F'r�lli .hl}_r:FTh,1Fia1,a. 1Ha <br /> 1.111k Ill i,h 16.Canlairyra <br /> 1:�1MIU.I',1I1111_ ZYVe o�anluy 11.un11 (^� <br /> I Iraa W'INd, �a.Waay CAdb <br /> y'� � Illlkll <br /> 4'�1 <br /> 1D <br /> Handling Instructions and Mtlitional Informal <br /> C-a_fsCY l;t?iV>•r1t; t'IE[:iI C i_14t3jj IZ43 (p <br /> i. <br /> MAR Iird ¢ <br /> and <br /> ablIO/Plada 'S CERTIFICATION:I hereby declare 1ha1 the coolants off,cansi nmem a1e1uH and accuraiel dascfihed ahwe h>he A <br /> and Iapeledlplawrded,and are in all respects in proper condition for transport acwMing to appiicaGle VntematVonal and hallo a1 ~ <br /> or,I Cantly that the contents ofthls coneignmenlconfonnto the lens of the ahached EPA <br /> Acknowledgmenl al Cansenl. y 9rP4er ddpg5tq name,am areaaasavad,Parkaged, <br /> n grnemmenlal l¢gu}aCron5,15 eygptt s>tilgm¢rt and4am4haPlimary <br /> •rt'that the waste minimization statement identified in 40 CFR Z62.27(a)(It I am a large quanl'dy genedgr or{hl DIY am a small quantity generalor}huua. <br /> rslblterors PrintedlTyped Nal r�- <br /> ational5hfpmenl5 <br /> ❑ ,''��''•�� r� <br /> Import to U.S., ❑Expod tmm U.S. y PShat enlrylev% O <br /> rter signature(for exports only): f5ate tear}ng11.5.: <br /> porter Acknowledgment of Receipt of Materials <br /> er 11PrintedlTyped Name <br /> S}gnaldie -•^—�_ � �j g191 0 vearT O <br /> f.i'f'•' .( 6'� �// / ,!�¢�'� _/ A,. '7 % L.�.-� ter...- �^ Mn115 Y � <br /> iter 2 Philt dityped Name le <br /> iscrepancy <br /> piscrepancy Indication Space 1:1 Quantity ❑Type <br /> OResidue l�PanlaSReyeclwn <br /> ManiiestReSetenceSSum4er, U.S.�PA50Wut}ltes <br /> Artemate Facility(or Generator) 10 <br /> Manlhl 9aI Nev <br /> HVs Phone: <br /> Sjgnalure of Alternale Facility(or Generator) <br /> emsl }` Notice:Sta o�Cali�nrnia requires <br /> to pnotatopY to <br /> azardous Waste Repoft Management Method Codes(I.P.. generator and mail <br /> 3 2. <br /> ,�tnllem 5Ba DISC with 30 days: <br /> Q ra Box aaa <br /> CA95a1�-aA00 <br /> t7esignated Facility Owner or Operator Cediticati Sactiamento, GtiN�W�ZU3,K% o <br /> (Q n <br /> a <br /> lied/Typed Name <br /> n 8700-22(Rev, 12-17) Previ <br /> 0 <br /> T cs' <br /> v <br /> w <br /> m W <br /> W <br /> 0 <br />