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otkn d for ifs i»t'e]tts # ¢ ()#ypgVvf�erb� <br /> :se pttpt of ty A 2,Pae 1 0' '3 E'ne.t r.cyRespon P Phone _ 4.tdanites!Ttacking Number <br /> UNIFORM f--v+RNUS ; se,e a,or,c �.>�: y; g _ _ 112177674 �J K <br /> WASTE MANIFEST. CAL dOO <br /> �9Q���� Generator=_;ire 4id'ess r f fi'fere;~than rnadina address) <br /> ` Gene tof's Name and Marina Add%55 <br /> S�auci3+v CA <br /> h. rp '00 <br /> , <br /> U.S.EPA 1D NwnDer <br /> 7.Trarispor',ar 2 Gort?r any Narilf <br /> ?.Cwsicn3;ed;ani?.{teama and S<,e Address���, �� `/����. � Com'/►Y(i�v r J.S.EPA lu Number . <br /> :3S41 OLD✓3Kp1j Vt- M -z <br /> F..dity's Pter�e: <br /> ga 9b U DDT Descriptgn('d1duding ProperShipprng rdame.Hazard Class,tD Nvmber. ?0.Containers t?.Total 12.Unit 13,1,Vaste Codes <br /> HM and Pack;rm Group(it any)) No. Type Quantity Vri i'Jci. <br /> G <br /> 141 Spec 41 H*Oing Instr wum and Ab(bbonai Irdorrm , <br /> 9,41 ) c,4 6►16Lit, �{ <br /> a7l <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:!teretry declare 1W Oe content of this consignment arefuily and acrurately described above ovemby r the p tsper shipping name,and are cias9fied,packaged, <br /> nrrked:and laluaedl iacatdea.anin d are alrr s to proper omfton for tranWort according to appil; le intema6ortal and national gr ental egufations.If export Stuprtlerrt and{am the PnrriBiy <br /> E4or.•er,I eeniy&M the mntents of 6s ronsIgnn*nt conform to the twins of the atlached EPA kknowiedgment of Consent. <br /> cert h N at tna vroste tr n;mizaton statemen?idem:redin 4C CFR 2b2:Iia;Irf i am a large t}uenuy aenwator)or(b)(r 1 am a skaR quanmy generator)is true. <br /> ;aria atu' e ors P nsted/T tame 1 Si u e <br /> ter' month Day' rear <br /> t cy �tri+C1 C i 1 <br /> 16 ntemationat.Shp ff--�� ` f— 2 i7 ' <br /> Importto U Sr EI Export fr..U.S. ort of entryiexrt: <br /> �. ;rdnsportersign2lure{(otaxpottsoNV�: - --- --- — <br /> Date leaving U.S.: <br /> W :17 Transporter Adoowledgsrertt of Receipt d"als <br /> Trans er 1.Printed.Typed Name S grta u2 Morilh Day ear <br /> Jai �t�Y1,t.l�✓ /,'l,-, ,� :r <br /> a <br /> z Transporter 2 Primed),))d Ntmre Sgnalure <br /> q Month Day (ear - <br /> 1b.Discreparuy t <br /> +rsa.Cisvepancy mer�rron Sr,xe !J-QLwtay Type LJ Residue (� �'''( <br /> t_t Partial Rejecton Ll Full Reteetion <br /> Manifest Reference Number: - <br /> 18g.AlterrafEfaclry(o Generator} ,. U.S <br /> EPA ID Numbe' <br /> eL Facifity s Phone: <br /> w 18,:SV.3ture of PRemate Facery(or Generator) <br /> Mond <br /> Z Day Year <br /> .1-9,Hazacdoas Waste ReportMar4W.ment M690 s(re;codes fortiazardcus Waste treatrrient ttisposa1.and recycling system9) <br /> LU _ <br /> i <br /> 20.Designated FacBrty Griner or Operator:Ce�Tical m of etei{!of hazareous rrratenaCs covered by the manifest except as ntled in item tea <br /> $lgflaiU2 ' <br /> bm— <br /> Month Day. Yew:,,. <br /> EPAkum n700-22(Rev,a-os).t=rovrous oditfons are ohs4i0ts. DE5tGNATtf3E�iT1PVATION STATE>;!F REt]IJtREgI <br />