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Please print or type (Form designed for use on elite 12 typewriter.) Form Approved.OMS No,2050-M <br /> UNIFORM HAZARDOUS 11,Gam,ID Numler 2.Pagel of 3.Emerpenry Raspal¢PM1a® a,11.1lest Track]"Number <br /> WASTEMANIFEST CAL Ooo3s9/O�, l FOO)g83 -37/8 1 nil S R Il I FLE <br /> 5Ge7;;P <br /> mEsea GmerMo(a Sire P4tlreas(gtlEfreM lM1an mNlvg aedress) <br /> zr b W W,IsITA:r � Zsu 4v.d*l+ SA"I <br /> sT "i.,?,Ca/( . 9SZe3 sI�Gc. 95203 <br /> . ralpadxt ommnyy rni U.SE NmMer <br /> llggJJ s� ? <br /> T.Tmropmor 2 Company Name US.EPAIDNumbar <br /> S.DacYnred Faal4liarreard IaMdona U.S.EPA 0 Number <br /> c/e w Ha rs 47'a? Al<inG[G <br /> gsul CAp98067s2-76 <br /> FildlWaPronal ll <br /> W. 1 9,.U3.DOT DesmPEm(IlMutlkg Papa SM1gpop Name,Haratl Cress.lO NNmba, to.tanbicers 1f.Tolel 12.UM <br /> HM wPadovg Group(Bany)) Na TY➢e No" wmJ 18.Wacm Cadet <br /> 0 11/oN-AcX4 a Wa ,Bali s!F/yAs ) <br /> �T P <br /> al <br /> w <br /> 3. <br /> 4. <br /> ad$pedal HmaMrG lnaWNmaaM OonN lnfameEon <br /> j, GH69/7538 <br /> 15. GENEUTORSroFFEROR'SCERTFILATroN: thereby declare lM1at Neanreno Of Nkcgnsgnmenlan NNyardamaaMlV Msrnhetl abpa by Me prgrer snipgng name,ane are tlaatifiaY,peNsgM, <br /> marked and labelaelplawreeb,and are in all respeck in pmperw nflinan fm Iranapolawrdrgloapplit tele Inionarional and rancral govemmenbl o,,uladona.11expdt shipmentandI am Ne Primary <br /> Exporter l wmty Nal the wmenb of Nls wnsignmenl wnlolm N tle lemS M Cw atlatlletl EPA AdmMedgnlenl pf Cpnsenl. <br /> s"a Moran Day wr <br /> I aNty Nat IM1e waste minimitagm saomenl aen6fiee In 40 CFR282]T(a)(E I am a Iagequanprygerxvabr)m(b)(EI em a small quanNy gerenoN is we. <br /> petl <br /> T s <br /> 16.InomaEore$M1ip a ❑ImpmtteLLS. ❑EtpoNfiam U.S Pooh.mroat <br /> Traraparair& reture fiar earl ml pale ken U.S.: <br /> w 1] slsorb'A dvgniad9mnlol Re�'pld MaMlvb <br /> K 1 Pn ( re ay ea <br /> iu <br /> aInruponer 2Inl Name ante l� y <br /> CF <br /> 1 18.Docrepar, <br /> 18a paayarey lMgeOgn Spew ❑ oal E]Tirol, ❑RnNae ❑PaEN RelerLon ❑Full ReRaBan <br /> ManikSl RMBIal NuoW <br /> IN,Alternate Faal(ar Gernal US.EPA 10 Number <br /> J <br /> Es <br /> LL Fxii PFare. <br /> y�j ilc SgreWRMNlemab Faolily(a Gerlaalpl MMN Dry Year <br />' 6 <br /> 2 <br /> —y 19.Hamrd:Ua Waste Repan MMajlmenl MBClad CotlOa PR,oci tar la]aNnLLe arlo naa 1,GrPRal,al r04YL5rpay9MIIISI <br /> 1. )4I S ` R. 3. 4. <br /> 20.Deagni Way Dan2la:CVNfa,a,01aEon of~ofluukwu railroadscantonal gesl by ft manearao ea riled in loan lEa <br /> 1 kN Wetl Nem ' $9 w1uR bE <br /> Vdol 77a! <br /> EPAI'M 8Z0M(Ray.O-05) Premorw adi8ons are obsoal DESIGNATED FACILITY 61 <br /> AC`ILITY TO DESTINATION STATE(IF REQUIRED) <br /> SC PPW 10/10/2017 _ <br />