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Please print or type.(Form designed for use on elite 12 Bch typewriter.) Far Approved.OMB No.2050-M39 4.Manifed Tracking Number WASTE MANIFEST %VROO", 1-ts f-P, :1 2.Page I of 3.Emergency Response Phone UNIFORM HAZARDOUS 1.C'ens"b"D Numb,- - 000197994 MWI F1 5.Generartoes Name and Mailing Address Ceneralor%Site Address(if different than mailing address) I Ir,Lt F,1,x 1.f! f-y F- r ltf,-I 4If 6«..._ ksi% 5ZON CA 6 Generators Phorie, 6.Transporter 1 Company Name U.S.EPA ID Number �`AR 0(P ? N'.1 I IN,0- 4!�r.I I flVi N1-f'?'1 i 7.Transporter 2 Company Name U.S.EPA ID Number 8,pesigjalled Facili�Name and Site Address U.S.EPA ID Number 17 1)4 V Arii!ix, i'.. 41-11)2, Facilit(sPhone: f-;,;i .,1 Lk `.I I i ga, Db.U.S.DOT Description(inducing ProlperShipping Name,Heard Class,ID Number, 10.Containers 11.Total 12.Unit 11 Waste Codes HM and Packing Group(ff any)) No. Type Quantity Wt Nal, 1 '19 W"v I t� t r0%1 0 Ff.111-f 1 N 0 N 0 ; *I P*t4-%'.V 11 Me'�,I`P V :5 tky F2tZ43i i 04 IN,;T f ID rr Uj —tv . I -0 4V Vtrp.At.0, Fr io 14,Special Handling Instructions and Addhicinal'Information I I T-, Dr.-4re I ops-r. ('P #0)1 t!21 ELI Lt..k r qA- 4; Ai-VAJ-Afft 0' "t*kGL WC. t.;Ie k,l I is t I tsa Wo# \1X-1 )'l )(3r, 115, GENERAMWSOFFEROWS CERTIFICATION;I hereby declare that the omtents of this consignment are fully and aocurdlely described above by the proper shipping name,and are classified,packaged, marked and labeled1placarded,and are In all respects in proper condition for transport aocordlng to applicable Intarnallonal and national governmental ragulaikins,9 export sihipment and I am the Primary Exporter,I car*that the contents of this consignment conform to the terms of the attached EPAAckricssdedgment of Consent. I certify that the wage minirmabon statement Identified in 40 CFR 262.27(a)(if I am a large quiardy generator)or(b)(if I am a small quantity generator)is true, Generaloift/Offerces PrintediTyped Name Signature Month Day Year 16.International Shipments El import to U.S. El Export from U.S. Port of entry/exit Transporter signature(for exports only): Date leaving U.S.: 17.Tr porterAdkrawledgment of Receipt of Materials T nor I PrintecIfType"ame Sight�w Month Day Year rn 771. Transporter 2 PrWedfryped Name Signsire-1 Month Day Year OG 18.Discrepancy 18a.Discrepancy Ind ratan Space R assnitity EIType El Residue 1:1 Partial Rejection ❑Full Rejeollicin Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number Fadlitys Phone: 18c.Signature of Alternate Facility(or Generator) Month Day Year 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. --T 3. 4. 20.Designated Ity Owner or Operator of recillit of hazesdous materials covered by the manifest except as noted in Hem 18a Signature Dw Year EPA Form 8700-2f(Rk MS) Previous editions are obsolete. DESIGNATED FACILITY TO,CjlNERATOR