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Please Frim or type.(Form designed for use on elite(12-pitch)typewrites l' Form Approved.OMB No,205MO39 <br /> UNIFORM HAZARDOUS IGenerdor ID N antra 2.Page 1 of 3.Emergency Response Phase 4.Manifest Trashing Number <br /> WASTE MANIFEST !r.L00037 165 1 t%1(!i)3Us+ 47rU 0133 6318 JJK <br /> 5 Gerer"s Name and Malting Address Geno(alces Silo Address Of dirkiwit than mailing address) <br /> ALCG IKON&FAFTAL,120 iN0. y y�lr lloAW DRIVE <br /> 1?15 NAVY DRIVE y % <br /> "■ .ro.. i0C'KTOiN CA 9-2;15 i(•OCKTON CA 9152'}. <br /> - oeeeiatcr'�rra,e 'rA X92-i t u7 . <br /> 6.Transposer 1 Corryany Name U.S.EPA ID Number <br /> ENViROPIfAED!TAL RECOKEft(6FRVICEf;.1D1C. C.A�,0 0 1)1 0,°2 0 1 <br /> 7.Tra.nspotar 2 Company Name U.S.EPA ID Number <br /> 8.Designated Fadiity Name and Stle Address U.S.EPA ID Number <br /> LIS ECOLOGY <br /> hMfY 55,1'c`M,LE hCIL17}I <br /> BEATTY rs: � <br /> Fedlift Pna,e m v <br /> ga 9b.U.S.DOT Desription(ndcdbg Proper Shaping Name,Hazard Caws,0 N i bv, 10.Carlliilto 11.Total 12.Unit 13.Wade.^.odes <br /> H..M ere pang G-9(d-Y)) Na Type Quantity wruvd. <br /> NON RCFj,WAF:DOIJ5 W.IAF;'E,5r_.L10(OIL,GE&F4a5) � <br /> Z 2- rJON KcRA E!A'Larmolm WASTE,SOLO(StNL,OIL) 7 <br /> D Ind •� 500 <br /> 3. <br /> 4. <br /> 14.Special Handling Instrudlansaodnddttoral Inlonnalon �,�,, �� - <br /> 9N11P)1'Y)-101f*-DIRTY A550MENT10ILYt.a�. �.a'� ERGW: 1.471,90Q 171 "ER5W.0.0!;:4180-ECR°' <br /> 9LF2:0701:9900.10163-9fiN0&.SFrJ;b�NT `,� � � 1�/-� <br /> 24 YR Ei IEKGEDICY CCIN'fdCT:ENYiR05ERV <br /> 15. GENERATDR'SIOFFEROWS CERTIFICATION:I hereby declare out the comerds of tllieconaignenant matuly and a=**desaftel above by One proper sh!ppng name,"are dnGftd,padraged. <br /> ,r erkad and rbeledlp earded,and are In all resaed9 in proper condition for trrraport occordYlg to applicable Inrrnatioral and rational governmental ragdal a s.N export ehlpmanl and I an Cue Pfkrwry <br /> Exporter,I certby that&..a contents of thb mrimyrnerl confirm to Ce ream of the atad*d EPA Ad riawledgrnenl of Consent- <br /> I car*Cal the wase mkdmirabon statanent IderMsel in 40 GFR 262.27(x)IN I am a large gljw"gerlaelc.l or(b)(11 am a smell Wanly gwwabr)Is true. <br /> Generalcn'vDNaofs PrIntedfTyped Name S:grwhao . 111111111100 YM <br /> 16.Inlenwtlond Shipnents <br /> F- otpatioUB aBwAmU.S. Pat offeriYyfaa <br /> Z <br /> — Transpartan spnahue((or exports Dory): Da roving U.S. <br /> IX 17.TrdgxrW dmoa4adgme4 of(ieapl of Materials•' <br /> Trarrsporlar 1 PrnleOfTyped Narnef Signeillnow yew <br /> Oct ,, rt , u�_•;!'� _i !.} r. ,.� .. .-•� �-d• �� <br /> � , <br /> 2 Tnrlspplsr aro- ,r ICnrI <br /> ---------------- <br /> list Disaeperey bldlcolbrl Syme ❑4wflly '❑Type ❑fierldue ❑Pertw Repcaon Q FIN Ft f dm <br /> Marillasl Rela ica Number. <br /> 181%Mwdk Fadlty(or Generator) U.S.EPA ID Number <br /> U <br /> tai Fadsty's Phone: <br /> 1Bc-Slgnabre o(ARemate Facility(aG more NY year <br /> z <br /> N19.Hazardous Waste Report Managamelt Meelod Codee Q.s.,codes for hazardous wwa a treaYnenl disposal,and recycling systarna) <br /> W 3. 4. <br /> 20.Doslgnated Faddy Owner or Operator CwM albn at raoso of hazardous mterlab covered by the nwrllest except as noted In Tern 1 as <br /> PdritedifTyped Narim Slgrwlure Month Day Year <br /> EPA Form 870x22(Rev.3-05)Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />