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!, yV "'til+ <br /> ase print or type. o pgr (316tB iNo:: 39 <br /> UNIFORM HAZARDOUS 1,Generator ID Number [2.Page 1 df 3.Emergency Response Phone 4.Manifest Tracking Number (t <br /> WASTE MANIFEST C.A.Li E3 01-37i630 933 ihO3 021239.023 JJ K I <br /> 5.Generators Name and Mailing Address Generator's Site Address(f di€ferenttinan mailing address) <br /> 'OLD CASYTLE SIERFA HI_r!!OiN, 'I Ip;-rr: � <br /> ,TWr Glffv.I_TEP 7 <br /> ST`C'r",TU(a;,CA 952!h <br /> Generator's Phone: 2-09-aE3-16GE4 r <br /> r� <br /> 8.Transporter I Company Name U.S.CPA ID Number <br /> r_S r C'}1d, f rairil=,IRr. <br /> AIR C00KI17019 <br /> 1,Tr nsp nar 2 Company Name U,S.EPA ID Number <br /> � �. lU` v <br /> 8.11esnaled Facilift Name aadS�.e Add ess U,S.EPAID Number <br /> rlcL s?I Y�_iF Ir,.s. iC74 �25S E <br /> i�ut.E�. ARE I(Si[rt#jC Irl <br /> L?,PXERSFIELD—Crib, 93317 <br /> Facifily'sPhone: pant- "c4258 <br /> i <br /> ga Ab.U.S.DCT Descrip€ion(including Proper Shipping Name,Hazard Class,ID Number, 70.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> Hh; and Packing Group(4 any}) No, Typepuan5ty Wtrtl. <br /> •Yo <br /> 1 I'dt_iltl RC'Rr"'HIAZ`:RY.r'U" v %STE'Se l.e'LD D131s <br /> 2. <br /> 3. <br /> E <br /> 4, <br /> 1 <br /> 14.Special Handling Instn:clions and Additional InformationVE <br /> ��:/3�/t,77lr� /� <br /> �.I�rn,.�i //��/ ( r <br /> l <br /> r <br /> I <br /> 15. GENERATOR'SIOFFEROn CERTIFICATION: I hereby declare that the contents of this consignment are Sully and atturately,described above by the proper shipping name,and are classified„packaged, <br /> marked and labefedlplacarded,and are in 68 respects in proper condition fortransport according to applicable intemti5oaal d national governmental regulations.if export shipment and i am the Primary <br /> Exporter,I certify that the contents of this conslgnment conform to the terms of the affached EFAAcknowledgment of Conse f. f <br /> I certify tha the waste minimization staiement identified in 40 GFR 252.27(a)(8 i am a large quantity generater)or b)(if I a a small quantity generator)is]rue. <br /> Generator' O(ie ors Plifnted[TypedlN ma Signature ? Montt � ry Day Year <br /> 18.International Shipmenls <br /> LJ Import to U.S. ❑Imxpoit tram U.S. Part ofen(rylexit <br /> r' <br /> Transporter signature(for exporls only}: Dale leaving U.S.: <br /> 17.TransporterAcknotvledgmentof Receipt of Materials j <br /> Transport t_p i ed Nam Signature Month Day Year <br /> Transpopw Prfn ndffyped Name I ignature if Month Day Yaar i <br /> 18. isc pancy fn''l <br /> 18a.Discrepancy Indicalion Space El Quantityy e �J ) <br /> ❑T pe ❑Residua �Partialet5on ft Full Re aeiicn <br /> i <br /> Manifest Reference Number: <br /> 18b,Alternate Facifity(or Generator) U.S.EPA ID Number <br /> Facility's Phone: <br /> 18c.Slgnature of Alternate Facility for Generator) Month. Day Year <br /> is.Hazardous Waste Report Management Method Codes(i.e.,Cedes for hazardous waste treatment,disposal,and reoycl;ng systems) <br /> a ' <br /> 20.Designated Facility Owner or Operator erittitalio of ceipt of hazardous materials covered by the . ife cep notedIto n 18a <br /> Prink d pe d Nan u nol �ayt �Y <br /> 1 Form 87 -22(Rc v.12-17) evin is e ikons are obsolete. ��i nl r jrY TO 4, 'S e-MANIFEST SYST`eft. i <br />