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D1'SC. 04236. 1853 <br />a,,,..., ......r... ti..a Form AAMad. OMR No. 20W -Mg <br />EPAFormW0MIev'10) PmAwsediW*ate i6dl te.�ESIQNATED FACILITY TO DESTINATION STATEXIF Rauulmk:u} <br />12637.2236 <br />UtF 01W HA?ARDWS <br />1. (wo=1D Nnmtser <br />2. Page 1 <br />3. Emergan.y Res ae T'flAise <br />4 ManfaTncWp Rumber <br />WASM MANIFEST <br />CAROW08nu <br />1 <br />Z 8m� bza-s'3�1tf3s <br />JJ <br />mail,g } <br />901 Do �l' PKWY TMROPrrA�1533E} <br />P.O. BOX 29243 <br />PHOEMA Az esm <br />son�Ooz2oo <br />cenara9or's PhNta: <br />' U.$_ EPAID Number <br />6'VXMb 1iALSERVFCES CAt}D53866794 <br />7. Trarmparfar 2 Ganp m Name EPAID Mm9w <br />6. argihrA�'Addsass US.E�rtiRD4014 <br />1630 WEST 117 7H STREET <br />LONG BEACH CA 84813 <br />600-827-6724 <br />Foal 4 Phare: <br />ga. <br />M- D.S. DOT DemVft (ndudhsg Praiser Shipping Noma, Hazard Class, M l t tuber, <br />1(. CDntiam <br />11. Totes <br />12. Unit <br />13. Waste Codes <br />No. <br />TOe <br />HM <br />and Pada# ftM P Myj) <br />Q=wy <br />WLML <br />1. <br />331 <br />cc <br />LU <br />M ) <br />DM <br />� Y <br />G <br />LU <br />2 ESEL t}DiY1004A <br />3m <br />3. <br />4. <br />14. sJ[3R IMI PROFtLM )100522 2)1 0533 <br />15. GENERAT*FtWDFFE3zMI$CEATtFICATIGN: I hereby dedom Ihat the tarderb of this cans4mmf I are hilly and acaaately desrxiCed atwvs by the paagrw sNppin9 tarps. ardare tdas 1. P 9 <br />madmd and lobetedVacarded, ad ars in efl mspacis In proper =Mm row trataport atoordhg to alrlombie intamatbanaf and naumai 9mmarital ragulatlortS. If ss W ship wd and I am the Primary <br />the cantertis of ttas c"pment orntform b dsa terms of the affaahed EPAAtfm ant of COWL <br />that gre 40 C 282,27(x} (d I am a large 4vm-UlY ) or (6} Off sm a arnd yuangty germtat o is true. <br />atterear <br />'"f <br />t <br />1$• PmerilsEl�fe>Iport Port Ofentryfe <br />htpart U S. U.S. :dt: <br />Tran�rtsr s]2= (far axports D$Ie feaving U.3 <br />W <br />17. TmnsporW AdurMWgMlg of ReDM'Df MaletW5 <br />Transporter 1 stud bee Month Day Year <br />Trxrsaportar27�tiptadffypedNams re Day Yet <br />18, DisuapaM <br />18a. Dlsoiepancy wica wt Spa p Qoaf, ❑Tips ❑ Reeid. ftU R*dion Fare R*Cbop <br />MasdiastReterepw Number: <br />11105 tato Facw (or Generator} US, EPA ID Number <br />r`5 <br />sa <br />a <br />FatBVs Phmm: <br />Sa Slgnattae Atternalm Paw(m Gwer;oc) MoM3t Year <br />19. Na:ardous Waste Repoa Management Malhad as (Le., codas �r ltatsndouawasfie treatment artd ratyagr� sytxarrss} <br />0 <br />1. 1,- <br />® S. 4 <br />N I <br />211. DesigWW Faatdy Omw or Operator. Cetkollen of roipt of hazardous covered by the ma ffast mmepf ae noted h Hens 1 u <br />EPAFormW0MIev'10) PmAwsediW*ate i6dl te.�ESIQNATED FACILITY TO DESTINATION STATEXIF Rauulmk:u} <br />12637.2236 <br />