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Ul 1 <br /> W O (S <br /> O N <br /> 1.Generator ID Nri O O D <br /> RDOUS r N <br /> G) FEST tube <br /> t:Ar._11UUi.l;l�ac�,s • <br /> N O E3 <br /> and Wlrg Address x P-901 a a.e O O <br /> rst:, r a O <br /> flJ lt�rt• Y. `^ereeno <br /> .SNC. I Qnw}'hone d1 <br /> fTl S r;._ ., ,.i WAN i'I-C:> L flLJ�t.JUfu l:)telVt_ Generabre silo Abd eq 111 tune a MenNat acN}np UAUwao-ea peg No Jai. Vii � <br /> _ W <br /> mpany Name rent then pp O <br /> (n n'Be1^Are rade GDF w Q <br /> r'�/Ihilc;AN V. 00 <br /> Parry Name <br /> flJt: '�1 <br /> 1''tJtJst2-i1YVILrt. <br /> cility Name and Sile Addaeas Nomper <br /> }-i I'AA Y'I:; Us Ph1pµ �:RHrNXJ'2f'g11� CIO'.i:.if31 i: �f l!r'Nt/jFi l l: i fiJ}yd wnner � <br /> •;Jr�i` � ,��:fwAY`'J:i ;il S:H tAt:Il11Y t;A1;l ILnJ1 i. <br /> c!; U.s.sPAlDNu ''n'r CD <br /> .DOT Description(alluding pR:'.11llra al!!ttdtt <br /> king Group(if any)) roper SI Pl:1 9 Name,}{arab Class ID Number, n <br /> O <br /> I-li'(;FeA f-E.�;• 10.Lontelners <br /> EV 121)f� No. tt.lotel t2.VnR <br /> -LIS In+i1;i" :�r 71 111,11.}`<{lF2 FlFr•1 T";,4 fill type Ouantky Wt.No. <br /> M <br /> I Inn51ti 1� '.lw:, 0yy <br /> CD <br /> r+ <br /> e--e <br /> n <br /> I Handling Instructions and Additional Information <br /> Pti.Fri I J'.J; i� i'lit::, .' ",::ri'7tSL:r�i'i,OH. F:'ttLSfh 171 � <br /> O <br /> ERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are IWiy and accurately descnhed ahme by me nm�ei xtnpgtng name,and are daeaMed,packaged, <br /> ed and Iabeledlplararded,and are in all respects in proper condition for transport according to apptitable international and national.govsmmtnial 1%10ronc.iS OW"IhtPment and I am the Primary <br /> rter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment oi Consent. rotor ishue <br /> 'fy that the waste minimization siatement identified in 40 CFR 262.27(a)(if I am a targe quantity generatorl or;b)(Ijbam e,ameN'quentlty gene.. 1 <br /> Signeturer, <br /> 19ratoeslOfOWS Printedrryped Name <br /> E>tport 11um U.S. Port of eni lexlk CD <br /> yemational Shipments ❑Impixt to u.S. Bate leaving U.5.: <br /> nsporter signature(for exports only): <br /> rran5porterAcknowledgment of Receipt Of <br /> Yea <br /> e Name �isl� r1�yi;rrd,f,. r" / <br /> f411 !! Signature <br /> apo ter 2 PnnledlTyprad Name r •`J y <br /> ❑PedlalAe�an 1.]FWIFawdwn <br /> liscrepancy ❑ResMue <br /> ❑TYPe <br /> Discrepanq indication Space ❑ Quantityr <br /> MenifeelRelrNettaNumhel• ug EPA Nu <br /> Y <br /> t ay YNtu <br /> llefriale Fatality(o(Generator) <br /> � Zl <br /> 'S phone: O tD <br /> f;enerator) a tems) n <br /> �nalUre of pllemale Facility(a Ir and rel p7 ri Notice:State of Californi and�mall to o <br /> generator to Photocopy a <br /> es(3.e•,codes for hamrdous wsets►+aat�p0t'dlePI <br /> Maea9e^Ygf1t MI, cod pTSC 1Nfth 30 days: e -- <br /> 2. -U <br /> y�pug Waste Rept �a�to item 18a <br /> p10 Box 400 X <br /> v �C recewt �T s�b�Ia fad by ltle fee a Sacramento r to 35&12.0400SaR'31N1�4A,I Gu'r d CD <br /> (D :CefG <br /> w <br /> _ w <br /> N <br /> 0 <br />