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\ ,U G� <br /> 853047-16 '.DT.SCUQ3b tch)ty�• 0077 �`- �l��! 2336892 <br /> Please print or type.(Form designed for use on elite'(12-pipewriter.) 0-7 42'1 1 ForanApproved.OMB No.2050-0039 <br /> UNIFORMHAZARDOUS 1.Genegor lDNumber� 2.Page l of 3.Emergency Response Phone 4.Manifest Tackin Number <br /> WASTE MANIFEST CALOOD613752 1 (877) 577-26159 000119389 DAT <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing still <br /> ,Suis it 9e9fbRg Services Sunit Wag Services <br /> 165 Inkstrial Park Drive 105 IDCastrial Park Drive <br /> GenereWrs Phone: Hall (A 95337 (2091925-3042. fiaDtoo W 95337 (2991825-3!)62 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 21st Century Environmental Tianaaeoent of California. LP CARD00210617 <br /> 7 ansporter 2 Company Name U.S.EPA IDumber <br /> 2� `x r� C c �,e r �, .c e -C x C)"c c. o c S U <br /> 8.Designated Facll"dy Name andSBe Address - U.S.EPAID Number <br /> 21ST CM112Y EIiVIRO13IFIfTRi KtgSEiff]ff OF EWA, LL6 <br /> 2895 REMMS DRIVE EAST <br /> FaclIll IsPhone: FE9Ji3.EY 8Y. 89198 17751 575-2760 WD980895338 <br /> 9a 9b.U.S.DOT Descripbon'(Nclddmg Proper Shipping Name.Hazard Class,ID Nanber, 10 Ckcl em 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(d any)) - IN Type Quantity WUvol. <br /> rc <br /> Uk1993 BASTE FLINNU LIQUIDS, U.O.S. DIIIffRR1'SPIRITS, D801 D019 F003 <br /> X SA58LIaE) P P6II RO11291=1611-41. 7 D5i 216 <br /> w <br /> 3. <br /> C <br /> 14.5;M Handling lnstmolions and Additional Information ` - <br /> (1) 753122-98 - ERSU20.IID9t)S SOLVEETS �- <br /> 15. GENERATOW84 OR'S CERTIFICATION: I hereby declare that the contends of(his consignment are fully and accurately described above by the proper shipping helps,and are classified,packaged, <br /> 'mal and labeledlplasarded,and are In all respects in proper condl for transport according to applicable international and national gmemmentel regulations.If export shipment and I am Ne Primary <br /> Exporter,I certify that the contents of this consignment conform to the terns of the attached EPAAcknmvfedgmenl of Consent. <br /> I cel that the waste minim'ua8on statement identified in 00 CFR 262.27(a)(it I am a large quantity generator)or(b)(dl am a small quandly generator)is true. <br /> GeneratorsrCgemes PdntedrTyped Name Signature - Moral Day Year <br /> c 1 m e a <br /> ri16.In temabonalStipments ' <br /> 1- Dial toU.S. ' ❑Export from U.S. Pod of en IexiC <br /> Transporter signature(far exports only): Date Is g U. :- <br /> 1T.TransporterAckrowfedgment of Receipt of Materials <br /> 12 <br /> Transfer 7 PrmtedRyped Na^� nue Mmtll Ory Year <br /> F.6r ©ln� so 3 l y / <br /> z Transporter 2 Printedrrypame - Sgralure // Mash Day Yea <br /> -Tod; z" i <br /> t18.Discrepancy I . <br /> 18a.Disompanoy Indication Space ❑ Grand •❑ - ❑Residue ❑Partial Rejection ❑Fug Raledhn <br /> Manifeel Reference Number <br /> 18b,Alternate Facility for Generator) - U.S.EPA ID Number ' <br /> J <br /> U <br /> LL <br /> Fill Phone: <br /> W 18c.Sigratioe of Aftemate Facility(or Generator) Mordh Day Year <br /> Q <br /> Z <br /> h19.Hazardous Waste Report Management Method Codes p.e.,codes for hazardous waste treadmill disposal,and recycling systems) <br /> wo 7. 2. 3. 4. <br /> 1 20.Designated Facility Diviner or Operator.Certification of leca pt of hazardous materials covered by the manifest except az ncted in Item 18a <br /> Prqe Name Signature Ml Day Year <br /> A f- 1� ('1 I .e. 5 -(I I(r <br /> EPA Form 8700- "(Rev. 5) Previous editions are obsolete. DESIGNATED FACILI IFY 10 GENERATORSTATE(IF REQUIRED) <br /> 12350.174818 2 4 <br />