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Please print or type, (Form designed for use on elite (12•pitch) typwifit@r. Form Ape roved, OMB No, 2050.0039 <br /> 1 Ger*ralor ID Number 2. Page n of 3. Emergency Resporaa Phone 4, Manifest Tracking um er <br /> U <br /> WASTE MANFESTuS `; ALUao � (ooa) 412493ao 018529431 JJK <br /> S. Gg it INTMOR"AlOftVICk GereratdtsS!!eAddress (ifdiffifentthanInabinQatldtass) <br /> + 39 tV CLUFF AVE STE D <br /> �LOOI Cis 95240 <br /> 209 339.1916 <br /> Gen etoes Phwio: <br /> 6, Tr LU �n RUNhiF_iV1'ALSERU)CtS U,S.TFP IDN}umbar _ , <br /> V4' V I� V « � i 1 f 036 <br /> 7. TrV(1FL� UNtt O 1VI- 1 t=Y$)'(=1s,i iftiG, IU.S. EPAtDNumber <br /> n9 <br /> VVV 1ry'I htt:t� trAR000175422 <br /> 8. DI Y�tVIAFYt t Cl 4 Ond $its Add zss U.S . EPA ID Number <br /> tZM0E13TH sI <br /> Feci' YUMA AZ 85368 AZRt000515924 <br /> tysPhone! (928);144-j4I3 <br /> ga ! 9b, U.SDOT OeseripUon Qnd zdiny Proper Shipping Name, Hazard Class. ID Number. 1 . Contains s 11 : Total 12. Unit <br /> 13. waste coos: <br /> Hf4: and packing Group (it any)) No, Type Quantity wt1Vd* <br /> I( DP'44RORA MA?ARUCIII ; VVASTE' , SOLID ( t) ILf SOUND , PAPLIFfL1tF?6 )CID <br /> a <br /> Uit4bb <br /> w <br /> RL: Utivmv <br /> MAY 2 2 Z013 <br /> 4 <br /> ENVIRONMENT � t <br /> DEPARTMENT <br /> 14. $peal Handling InstrucUons andAddiUonal Inform Oen <br /> I <br /> I.&MERGENCY CONTACT : CHEM" REG iw8OO-414 -9;300 WOrS rtRfAl (dAL: -h& NFtOFIL(: # 9r)1 : :>_0t>623fas > 1.AN(343 u1L�t St)LID, <br /> PAPER FILIvOS dt " APPROPRIATE PPE EQUIPMENT <br /> 15. GENERATOMWOFFENOWS CERTIFICATION: t hereby declare that the conlents of this consignment are futyand accurately dossidred above by the propel Eh;pp pg tram*, end Oro classted; pac'xaged, <br /> maryed and raboladrplocerded. and are in ish respects to proper ccDdVon for transport according to appixab'o international and national govismim tai regulations, it egort shipinenl aria t am the Primary <br /> Exporter, l asrtiy mat gra c Iona of WS colleigninonit conform to Ura terms of the attached EPAAOAo%isdgmont of Consent <br /> I comfy DMI this waste rrJn n I Itet on statement Identified In 40 OFR 262.27(x) (d I am a largo quan5tygensratot) a (b) (if i am a WAD gmNity gonowkr) is true <br /> n§ . arvrsFrr�dn; r ,.� vnme urs /1 / Nanm Day Year <br /> J 16, Inlema0ora) .Nprraras (--� <br /> F l ._ I Import to UIS, Export from tv putt of entrvlexit: <br /> z Transporter slQnalute (for experts Only!;IRE Date IcasiRg U.SA <br /> � iT. 'franspoderAcamaatedgmentalRecelptotlialeria!s <br /> 7rar, ports d re@Typed ams Srgne4uo Month Day Year <br /> a <br /> 73FAAA ,v 9 <br /> T q ponar2Prim yged Name Signature Month D�ayy Year <br /> h� e- / G '� log <br /> 18. D.ecrapans; <br /> IBa; Dlscnapeneyinrrcation $pacs Quantity _ lTyoe ❑ Residue QParualRejection El Full Ro)ecUon <br /> MiNfest Reference Number; <br /> iBh Mo."alo FacIly (or0oneiator) U,S. EPA ID Number <br /> U <br /> LL Foa, y's Phone: <br /> UOj 18c; Sigon1woof AlleminoFacilty (or Gonotolor) f'ort'h Day 'fear <br /> z <br /> 19, Hazardous Waste Report Management Method Codes (i. a. , cotes forliazardoss masio trealmont, disposal, and racycGng systems; <br /> 7 24 3: d, <br /> 20. Designated Faa'ily Orner or Oporator;.Cbrtification of reaa:pt of hazardous malopals covrrei by the man?osl except hsc In Item 180 <br /> ftled/fyped signal ureDay Year ar <br /> zMalm P . I J16 AA k I %��l I np I IO <br /> EPA Foim870t)• 2 (fiev, 3.05) Previousetlhons to obsolete, m.sIQIv 'mm I~ACII.I1Y1' 1) " " :INAT'ION STAVE: (IF REQUIRED ) <br />