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sc Pew 7i1s,�24i8 <br /> Daae Ord or Form tlesigrted for use on elite 12 ieh ter a�7F Form .OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3. R Pligte anum klag Number <br /> WASTE MANIFEST GAL 0 0 0 3 5 91 0 2 1 i8 r)4s�718 01 1974322 FLE <br /> ttlt t�n"Address Geaeralors to {Ir ererdthanMM address) <br /> 2526 W.Washington Strut 2526 W warhini"n Rtroat <br /> LL'+ wry.r-A n,�r~{-rn'> ,iuLI--t,^ mmnC3 <br /> GeneratorsPhorleWONV r-3700 ATT�l.efamr Nuflmafa <br /> Transporter U.S.VA ID Nr rAW <br /> i0o01A--.-.J,64 St1 G'ArLc00?sJa�i I la <br /> I Traneptrler 2 Company Name U,.EPA ID Number <br /> 8.Desgnaled Facility Name and Site Address U.S.EPA Io Number <br /> Clean Harbors Buttonwillow LLC <br /> 2500 West Lokern Road <br /> Buttonwitlow.CA 93206 <br /> Facilil s Phone: (66il 762.6200 <br /> 9a, 9b.U-S.DOT Description(including Proper Shipping Name,Hazard Class,0 Number. 10.Containers 11.Total 12,Unit 13,Waste Codes <br /> HM and Padang Group(if arty)) No. Type Quantity Wt.Nol, <br /> 1 UNV59.CORROSIVE SOLID b.i <br /> 0 x S.K III,MOTTOMASH) I �� y%tqQ -- <br /> z a: <br /> w <br /> co <br /> 3. <br /> 4 <br /> 14.S acct FIan�Instructions and Add!1' Information <br /> 1_�H13453a0 EB6154 <br /> Cartract retained br aegerator corrrers agency 3iitnvily a ,Irt!tl3l lraflsDArier to add or sUbstltUte aGnlortal trarsoorter:_ 0'. arr_r:tlop a=0.31! <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contends of this consignment are futy and accurately described above by the proper shipping name,and are dassllled,packaged, <br /> marked and lebelWplecarded,and are in all respects in proper condition for transport according to applicable irremetlonel and national governmental regulations.q expod shipment and t,am dre Primary <br /> Exporter,I cerwy that the contents of this consignment conform to the terms tithe attached EPAAcknowkdgment of Consent <br /> t certify that the waste minimlzatlon statement Identified in 40 CFR 26227(a)[d f am a farge quantity generator)or(b)(d I am a small quantity generator)is true. <br /> s gna ure <br /> J 16,Iniernatltxr Ship Eli - <br /> >— ❑Import to U.S. L1zport from U.S. FA of err exile: <br /> Z Tran swoure fur Date U,S. <br /> 17 TransperterAcknovv e"rd of Receipt of Matelots <br /> TmnGpartar 1 PWOWTypecl Name offi WY Tew <br /> y Zd <br /> 7r.-ncsWfw z Prlr"Toed Nano �� yew <br /> r _ <br /> 18.Discrepancy <br /> 183.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑F a Rejection <br /> IMarafest Referert a Nanton <br /> 18b.Alternate Facility(or Generator) U.S,EPA ID Number <br /> J_ <br /> V <br /> w Farakl s Phone: <br /> w 18c.5igrmk,realAticrnate.adut<(a to) Month Day Year <br /> 4 <br /> H19.Hazardous Waste Report Management Method Codes(4e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> N132 <br /> 20 Designated Facility Owner or Operator:C dificatien of reoeipt of hazardous materials covered by the manifest except as noted in item 18a <br /> Prin yped Name I `� " signature y wI Month Cay Year <br /> I a Iso <br /> EPA Form 8700-22(Rev.3-05) Previous editions,are obsolete, PA&q j%ED f#.((_ITY TO DESTINATION STATE(IF REQUIRED) <br /> -lean harbors has the approprtate permits for anti will accept the waste the fene <br />