Laserfiche WebLink
10 <br /> Please prird or type.(Form desigried for usp h 92-pi")rypeOW.) Form Approved-t'JAAB No.2050 . <br /> UNIFORM HAZARDOUW <br /> T.(�erterabr ID Nurrba 2 Page 1 of 3.Fmergericy ReWw Phone 1"MM317 <br /> �{�,C'. <br /> WASTE MANIFEST r At <br /> 5.G egfs Name and MaYag A (If dAferert fimrn maTag address) <br /> _ s la�trtiai�il:� <br /> P 0 X7372 Iwo N.ftadkvWAcre <br /> We.CA 913W Ston#on.CA 96'M <br /> Geoatefofs <br /> 6 TorMr 11y Nave' U.S.EPA ID Nember <br /> �rMroaa rt�sc :� C�.�i18 <br /> 7 Transporter Company Name U.S.FPA ID Number <br /> 8 Oeartt�dFBiMI{rtQamie as lSeaAdd esa Nares�UI$iirori�iD�r Lt£ U.S.EPA ID Number <br /> fq�1 L4Waerrt AZr] r-,:ptj}�g7�,278 <br /> Fac3ty's Phone-W'"OJM <br /> ga. 9b.U.S.DoT Desaipbon Wuft Prrp�Stig*g Name,Hazard Ck;%ID Number, 10.Codainem 11,Total 12-Unit <br /> HM and Padang Graup(zany)) No. Type Quantity WtNd. t3 1Yaste Codes <br /> 1- 4 R:PA Aozwdaus'M :• `Sftr,_^:l'-:C.M►kRE"i_r > Debris ;�t;? <br /> UJ ` <br /> Z 2 1 <br /> W <br /> 3. <br /> I <br /> t <br /> 14.Special HandlIng instrllclims and Additional I r <br /> oation <br /> t Prt�por P.Pli <br /> s. G13iCdtATOR S10FFEROR S CERTIFlCA :I hereby dedare that the comers of this omp grunent are fury and acauahely descrbed above by the proper stuppirg name,and are fid,packaged. <br /> marked and Iabdedlplamrded.and are ina9 m proper condition for transport a—ugJaappirable irtamabonal and rk&r l govenrmutal rergAa im.a export shipment and 1 am the Primary <br /> Exporter,I carlfex <br /> y Ow the tents of ft conform to the terms of the alladred EPAAclmOed9rrent of CorrserlL <br /> I certlfy flet the wade mikirmzation state+ren identified in 40 CFR 262.27(a)(d 1 am a large quantity generator)or(b)(d I am a quantity generabr)is true <br /> GeneratolslOfterors Ptmtadlfyped Name SignatureflAonth Day Year <br /> Kar►de�,i► � � d� 1;�.. <br /> J 16.International Stdpme is ❑Expod from U.S. Por of <br /> F ❑Import t�U.S. en6y/a al ---— — — <br /> Transporter signature(for exports only); Date leaving U.S.: <br /> W 17.7ransporterArJotowledgmenl of Receipt at Motet& <br /> Transporter 1 Prirdedlfyped Name SiyeWre Month on Y <br /> a 05 J l� P <br /> Z Transporter 2 Pr0ltedlfyped Name J� Month Day Year <br /> H <br /> 18.Dtscrepanty <br /> taa.Discrepancy Irdcadon Space ❑ Quantity F1 Type L J Residue El Partial Rejectbn ❑Full Rejection <br /> Manifest Reference Number. <br /> IZ 1 Bb.Alternate Facility(or Generator) U.S.FPA ID Number -- <br /> J <br /> U <br /> tai. FaciliVs Plane: <br /> W 18c.Signature o(A1lernate Faddy(or Generator) Month Day Year q <br /> Hca <br /> 19.Hazardous Waste Report Management Method (Le.,codes for hazardous waste treatment,d'aposat,and n KycWV syslams) <br /> c 1. 2. 3- a <br /> ti32 <br /> 20.Designated Facky Owner or Operator Ce' of receipt of hazardous materials covered by the manifest except as noted in Item I Be <br /> PrinfadlTyped Name �� ��., �- Signature -� Month, Day fYea <br /> � r . _ <br /> EPA Form 870022(Rev.3 05) Previous edrtlons obsolete. CESIGNATED FACILITY TO GENERATOR <br /> � I <br />