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P Ieseprint or type. OUS 1,Generator ID N Form Approved.OMB No,2050-W39 <br /> UNIFORM HAZARD 2.Page I of I Emergency Response P 4,Manifest—Trm"kim Numasr <br /> r!L <br /> WASTE MANIFEST - 1 (877) 577-266} 0M75092 FLE <br /> Name and Ma4tng Address Generator's Site Address(I dlff—eier—ttha, mail anorm) <br /> Marshalls #Mojai� Marshalli#MO,12a <br /> (209) 952-7870 EaVI3 Grand Canal 2203 Grand Canal <br /> Gerieraws Phone: --- Stockton, CrA 95207 Sto--kton, CA 913207 <br /> C,Transporter I COMWY Name U.S.EPA to Nu W <br /> Stgric'Vcl@ Specialty Waste Solutions Inc __LMNS000i 11109214 <br /> 'o <br /> U_ <br /> 7.Transporter 2 Company Name S � <br /> PA 10 NVIP <br /> -- Worldwide Re ... <br /> oy.e.ry Systems <br /> 6,Designated FaNq Nium We&w Address yUXa .......... GAR000175422 <br /> Yes, LLC U.S.EPA,ID Number <br /> 2730 E. 13th Street <br /> F Yuma, AZ 135365 <br /> ga, fib.U.S,DOT Desa0w(mcluding Proper Shipping <br /> p Name,Hazard Class,10 Number, 10,Containers; <br /> HM and PaddN Group(d any)) 11,Tmal 12,Unit 13.Waste Codes <br /> No. Type Quao-ty M./Vol, <br /> Won RRA hazardous waste, liquid (Consumer I DF 00145 P 331 <br /> Products)f <br /> M <br /> LUon RCRA hazardous was7e, solid <br /> C.5 Products), (Consumer 1 F 00153 P 331 <br /> 3, <br /> 4. <br /> 14,94M Harding;;Z�0's 3"700ruoriaf treormatiort <br /> Regulated Solids) 1. 102338(CA State Regulated Liquids) 2. 102339(CA State <br /> lb. GENERATOR*S/OFFEROR'S CERnFXCA :I hereby declare that the contents of hs cons;nrwt are fully and accurately it--, 'bed above tyy!he proper shtppg n <br /> marked and labeledVacarded,and am in aft taspects in proper condtilon lot transport cn ng ame,and are classified,packaged, <br /> ao0ordwitI to applicabhe International and national govemmental reguialt q export hiPtnent and 1 am the Primary <br /> Exporta,I to"that ft Wnto'lts of W tear tOrMS Of thea 0ftcWEPAA0n7wWgmerit0fCWseni or's s <br /> 1 certify M31 the waste minimization <br /> Gtnarat' sr 'S ftwlyped NSignature <br /> ignature <br /> nera is L-9. <br /> Year <br /> 0 <br /> 6.In . bra I' ll nis 07Z 1 13 <br /> import to U.S LJ epoa from U.S, Port of m <br /> bjeTransporter sig,,li ya .......................................................... ... ... <br /> U= '?.7 Acknoivir�, t ot Receipt of iviaengs Date leaving U.S.: <br /> Transporter 1 PrintediTyped Name <br /> ii <br /> Signature Month Day Year <br /> V D <br /> 9 Z WSuture <br /> � 15PUTIOr 4 ennIKI typed NaM 4 7 <br /> 1= Mi� LTaF _Y47 <br /> t 18,Discrepancy Ro <br /> 18a.Discrepancy Indication Space ype T <br /> El oufity D R.Sdue Partial R*cfion Full Rejection <br /> IM Alternate Facility(of Generator) fAan fast Reference Number <br /> uQ Facility's PW e: <br /> Uj i&c.SrgnaveofAftemateFactfity(or Werator) <br /> Z Month Day <br /> f.Hazardous Waste Report Men8ge"At WItiod Codes(ie,,colles;for hazardis waste treatment,dIsp and r0eydmq systems <br /> W o' m Mal, <br /> 7.— <br /> LAI <br /> 20 MqVW f�acifity Owner of Operator Certification of receipt of hazardous materials covered by the manifest except as neted in Item 18a <br /> prin Name 0 except <br /> Item <br /> S4gnature Year <br /> ne"") <br /> EPA form 8700-22( ey.vj i) Previous editions are obsdolele. <br /> F4ATED 4A <br /> D ES C1 TO EPA's ilMiANIFEST SYSTEM <br />