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DCl) M..i <br /> '' Ort N CO <br /> O r s 0 0 W <br /> OMB Na.2650.003 � N <br /> APpfOved. O <br /> D FOnn Gg <br /> 4 Manliest Trac <br /> Atn9 Hpmpar s <br /> D <br /> ORespott�phwie I <br /> z <br /> 2 papa 1 1( 7 EmeryencY ss( ddre55) _ <br /> 1_y20I <br /> M pwo pnnt rX type' t,GenMt�ID Nrarder t d dilrerent Nan malting a O Q <br /> UNIFORM HAZARDOUS fJIL0001�]�1 Generelofs Sita�dfe <br /> (n WAS MANIFEST BLVD <br /> s e a ds Nemo a"wihi gAdd Ault t 57 8 ffi TRNC't Q <br /> n °° <br /> ywCIYICC6'1'1TCs1417t� TRAC�r�CA U,S,EPAIDNumber O <br /> rRA('y CA 06378 <br /> umber <br /> r 7 Con4er7 Name ' US,EPA10 N _ <br /> AMF RI4 rAtJ VAL LtY yyAL"TE rill. IN:.: 3 <br /> T Yrenr 2 company Nina S. <br /> US.EPA ID Number d S <br /> vytii A7WO)S1 ' N <br /> a aesgnaled Feoiity Nems and�re <br /> Yt#AA Addressvi LLL: <br /> P � <br /> 2730E 13TH ST Q <br /> f yLN,4A.AZ 11 12.Unit 13.Waste Codes O <br /> 10�Containers 11.Total WtNoL <br /> Faciiirys Phony Type Quantify (n <br /> (nddi^B proper Shipping Name,HezaM Class,IQ Number. Na.9a. 9h U.S.Ooleon}} 2 <br /> Hh1 and peckov r1�A 1rl,7 Sa <br /> I � <br /> SOLID.ABS'ORBEW.; Vft rt <br /> X Mev4-RrRA KA ARD011S WAST (D <br /> a OFFl�t" v <br /> w <br /> 7 <br /> z <br /> w <br /> r-e <br /> O <br /> O <br /> � N <br /> 4 O <br /> 00 <br /> N <br /> 14.3,-del Harming InsovcLons antl Addi0onal lnfomration t) <br /> 1'ROFIL[ ASSPIZtlENI.OIL PHCaT�171 W <br /> I AC i ttALYH <br /> l er shi in name,and are classified,packaged. O <br /> f <br /> 15. GENERATOR'SlDFFFROR'S CERTfFrCAT10N:I hereby declare ado ec contents according t0 applicable ilntomationalandy national algovenmental regulations.if export shipment and I am the Primary Ln <br /> mat,A and laaeled7placarded.and are in aF respects proper (D <br /> &barer I certify It,the contents of Nis consgrrmai conform to the terms or the attached EPAAft0y ledgmert of Consent <br /> p generator)Is tme. G <br /> I oei that the waste minrruzatan statement identified in 40 CFR 26227(a)(g I am a large quantity generator)°r(b)(if l am a small quantity g ) Month Day Year - fD <br /> Signature O_ <br /> GenerdtorstOtferors Fiinledffyped Name ` ...1c 1 ( A r C <br /> '���, < <br /> f-r <br /> J 16,Inlamalanal Shipmentsw Import to U. . ❑Export from U,S. Part of entryletul: <br /> ❑ S <br /> r Date leaving UB.: C <br /> ? Transporter signal rm(for--ft only): r-r <br /> X 77 TrainsporterAdmodalgrnentofRec801ofMaterials _ to <br /> F Tin , , r Signature 1 =w Month Day Year <br /> CL <br /> ature Month ay r Q <br /> 2 Trans 2 Pr'r.tadlT _ Sign �-:� - � Q <br /> ✓'� rD <br /> ,s.D�screaancy w�' <br /> t Ba.Disuepancy Indication Space 0. .. Type ❑Residue ❑Partial Rejection ❑Full Rejection rv-r <br /> rD <br /> Q <br /> Manifest Reference Number <br /> 1Bh Memale Facility(or Generator) U S.EPA 10 Number O <br /> J <br /> U <br /> LL Faial:rys Phone' O <br /> LLD 1&Signature ofAlfealale Fadlily for Generator( Month Day Year �] <br /> a t fD o <br /> z I O p <br /> yf9.Hazardous Waste Report Management Method Codes(i a Codes for hazardous waste treatment,disposal,and recycling systems( QN Q <br /> 0 1 z, s. Notice:State of california requires O <br /> otoca3 _ <br /> py and mail to <br /> generator to Ph * <br /> 20 17esgrt1led Fading Oemer of Operator.Cert(heation orreceipt of hazardous materials covered by the manifest except as noted in Item 18a DISC with 30 days: rrtp <br /> PrmtediTyped Name Signature O <br /> � P.0 Box 400 1 <br /> m :PA Form 8700.22(Rev. Previous editions are obsolete. saeramento,CA 95812-040() o <br /> -P, utNERATOR S INITIAL.COPY m <br /> 0 <br />