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°n <br /> Please priritnr:lype. <br /> Frim Ilppmved.OrtiIB No, <br /> 1,.Banaratar ID NumliEr' 2.Page 1 or 3-Eme. e <br /> UNIFORM HAIARD(W rg ncy Response P l ManffestTraekl. Hu�`mtwrr.Q Q <br /> WASTE MANIFEST CALO$.{F405? 1 (877) :577— <br /> 9 V. V G.sJ V <br /> &Generatoft Name and Ming Genaia—ds sm AdAddress Prim iiiwn maifrng midress}. <br /> 1999) 999-9999 250. E Harney Ln2 50E Harney. LTt. <br /> General&S Phone: Lad i CA' 952 <br /> 5-Transporter 1 Company NameT �r <br /> .. } <br /> Lew.�L L WAeS SS ! r "`� lvrC'� U.S.EPn IQ Number <br /> R.r7esignaled Faelsiy Name and SileAddnw <br /> Rha .Cheng I S.EPA IrSHurnbw <br /> 425.. I5 i.S Avenue <br /> IngleUl adj 9036}. <br /> Fa.CiGl�5 Phone: . ' <br /> 9a: 4b:U.S.DQTDesppffion.(r du�rg Proper SFv Name,Hazard C #T Hurnhor; 111..Confainers 11,Totaf :. 12 Ur# <br /> ,HM e9 Group C4ap1}} Na, T Quantity WtfVol.: 13.Waslb Colles <br /> 1.Ron RM wasIte', soli <br /> a <br /> Regulated Products), .., <br /> w <br /> y 2. <br /> est <br /> C7 <br /> 3. <br /> 4. <br /> 14p.Special FWRg Instmiloas and•Addil 99;M;!;:, <br /> 15. 41ENERATONSMUMCIRS 012RTTECA7EOH:Thereby decfaia that oonfenls.of 6 .0brisi meniare fidly and amurafely&$Ofbatl.' .. 'bylhe prgPer.shlP1? 9+ e;aTdare classlifed.Pad edr <br /> marked and.labeledlPlacarded and are al afl.respeo[s7n proper ooaiditian transportaccardfrlg io <br /> awe"htmalion.aland nelierel go ain Flerital reguf�orrs:Ifexpo$sElfpnieniatltf l are the Pr6nary <br /> Exporter,FCeAy tlla the oonlarf3 oTthisto am of le afthad EPA.Admawledgwe tof Consent <br /> I certify Ula[ihe.aasta r�tian stafenlerd ident fieTf In 40'CFR 282,21 {'d P arti a huge quantity generator} 1=As quanttor}is tsve. <br /> Be Dftem s Pari Wryped Name: lNonyr Day Year <br /> ii <br /> J 15. IErrlati0naf St1• <br /> ❑IMort fa U"S- ❑F.xpor 6..U.S' Part e <br /> Transww w9nahrre(Tor exports 0*Y Data lea S <br /> a 17.TrarislxxIwR w44r=Aef Reeelplof Ma KI& <br /> ► Transporter 1'136rtedLTypod Harno. S <br /> .. t •..[Tay esr <br /> ate' -K—rista her A,l'6 ani <br /> TramspoW2 Name <br /> Day; yam <br /> 18.ft��pancy , <br /> 18a.Disaepanry.lndica4gn apace Quantty ❑Type Res due. ❑Pa*l RaJnction ❑Fup RejecSan <br /> Mao ifestRefen=;e Humbe. <br /> 186;Allemale Faalily(or errerakrr). U.S.EPAED Humber <br /> Fadowa mm:U <br /> 18c.'Signswe ofAltemate Fed UtylorGene <br /> IMMM fYiy YBef <br /> Q <br /> 2 <br /> 19.-Hazard f2eport T�larregerltent F,fathod Codes.{i e„Codd tar vrasts§dalinersT'd ;and rewdi g sy§foiris} <br /> LU 1: <br /> C] 2. 3.. 14, . <br /> 2D:Des' fAmer Cpe '. ;Cte... leFeaz rdoats teriats;oav�ed by re. lq.Itcem sa'' <br /> Pri [+lame . <br /> Dw Y <br /> Ana orm 0-22:(Rev.12-17) Pra+rivusedifioRsare DESIGHA ED PAci ITY`iQ`EFA'�'e-�i4. FES�SYSTEhR. <br />