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Please ppnt:or t pe (Eorm:desl nod(or use ori:'elite(12 pitch)rypewOter,). �`t.•. ;.:. j?,:� x Form AoDfoved,OMB No 2030 003Q <br /> r UNIFOhNt:HAZARDQI($• 1:'GrxlBralor ID Number 2 Pegg 1 oP EeAaigency Reapdnte Phohe 4 Manifest hackln Num <br /> WASTEMANjlER a,PL@ �?7IFi�J�:. �'. Xr t�N1Q jttyl( 17(5t <br /> b.GeneratorsNarrieend MellmgAddres$.. <br /> X052 GinsfalbesSite Address Ifdlffdrentihanmel6""ed rens <br /> r. F lc1i7 .Irai3 And �me ( .pg tl. ), ., _ <br /> i"S15`Navy TJr �� <br /> ,�a`fGCF(•I•fJ(4 t;f 1 5!(acfQfa•�i 17t} _ � -•+- :��...T. <br /> Generafoes Phone: a •77.1 <br /> • b.Transporter 1 Company Name U S.; A 10 h(umbef,' •- ':: .• =� r <br /> :� —6.4�-y-yiLE`Qq SYSTEMS INE :'i;IR�1��+t�1►3g�?t <br /> 7.Transporter 2 Company.Neme: ' <br /> . ", •'•U:S:•EPk'ID•Nbrrjtar�l <br /> &Desl <br /> gnAted Facility Name:grid STIP Address <br /> CI.ERN IiA T315k� :.�aYah1 �I}a .LLC. us ID,Nlirribdf: , <br /> :,SAl� Jd `CA. WIWI <br /> Fadli sPhone: 408-4•ifi=�g6L. i`�F1�17®�^?�t�4�:1$`" <br /> 9e. 9b.11.5:DOT Description(including ProperiShipping Name,Hazard Class,ID Number, {d;CdllBtrlere T.11.T ;12 j7nft <br /> HM and Packing Group(Ifany)) <br /> 1 <br /> NON-RCRA HAZARDOUS taA I,cit�z��e�, p�:. .. P . <br /> tALa+;U'BENTS CONTAMINATED WITH OILT, <br /> . 2 <br /> 7-7 <br /> r. . <br /> 14.Special Handling instructions and Additional information L.70 <br /> (-)R C.11C'RB-4CY t F340-4663.%E:M) 7f I),` � <br /> 15`'��E`lV RA ra'SI RBkrSC TIPICATid :I Ya de 11'eilialIhls „Ibts fihl'r ga Rafe, Ifyanil' nfald�d bgna ova Y APfob�F9frp ingneinelaglprecla6s>fledipeckaged;, <br /> marked and labeledlplacerded,.and are.lnall respects In proper condlllon for transport according to app!cable Inlematlona(and natidnal-govemmenlof iegula4ohs.If airport rlhlprr(eht an1}I aht the Prfinery <br /> Exporter,I certify that the contents of this consignment conform to the terms ofthe aliached EPAAcknowledgment of Consent a <br /> I cedlfy that.the waste minimization statement Identified In 40 CFR 262.27(a).(If l am a large quantity generator)or @)(HI oma sniatl quantityge,ere r)le mre <br /> Ge erelors/0 aro s Prinled/Typgd Name Signe use <br /> J .6.International Shipments <br /> Import to U.8 0 Export f ar�r U.Sr_ Po eNIY - , <br /> Transporter signature(for exports only): U.�f.`• , _ <br /> l7,TranspoderAcknowledgmenfofRecelptofMatedels a <br /> Trenspoder1 nn ed/Typed Namej r Slynalur * + ,•Mpn4r DAx: .:Yeec <br /> iYanspodarEprintedflyped NamTSl elute7 I•' <br /> :Month:' -'Day'-' Year <br /> 18a plggepe Cyjridleatlon Space... <br /> 0 Quantity El Type 0 Residue <br /> z,.....' <br /> Manifest ReferenceNumbery <br /> 186.AI1eN Fedly(or0enerator) U,8',�PAIDtdpntler':': <br /> Facility's Phone'. <br /> r1�c.Slgflature oKlomate.Faculty(or Generator) <br /> ear.' .. <br /> as *.Hazordcuti Waste Report Management Method Codes(Le,,codes for hazardous waste treatment,disposal,and.rec clin a stems <br /> �:J2. --------- <br /> 20,'Designeted FAcll(ty Oviner-or Ope7aloc Cer4)Icatlon of receipt oth4zardous:matedele.coverad by 8je maul/est exr:ept nafeQ N <br /> Pri4etn,18e <br /> nts y j ed Name j� Signature • : <br /> °7mvith Day.: Yeer- <br /> -zeEPA-Form 8700-22(Rev,3-05) Ptevlo"us edition re.obsolete. v "" .,. <br /> DE A D`FACILITYTO_GEN FiATgFt. ; <br />