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Please print or type. �s d,+gFrFForyin Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Ganeralor ID Number 2'Ppet of 3. �dram Petra a00U 't .a 3.799 GBF <br /> WASTE MANIFEST "" <br /> 5.General Nmre and Witlrs Address Generates Sia Md.(I droment ban maidirp address) <br /> :"ON PROPELLER <br /> N WILCOX RD <br /> e31UCa(TON,CA 995115 <br /> GBIIem.pmnb(1H 9a2dCKI&i05 <br /> 5.Trampmmr t G rn eny Name AVS,EPA ID Number <br /> MtRiCPN VPA.LGY iNASiI:U1L. IN(:. CANOUJ2%130:. <br /> 7.Tramponm 2 Canpany Nare aiU.S.EPA IO Nambsr <br /> l-RI(:yCLE SVtCIN.IY WASTE S'r1Lll1I(NIS. WATiS(HA/If1U24 <br /> a.Designated Fetilay Name and Si eMd..11ElA-RANIall WR W VA,lLC U.S.EPA ID Number <br /> 11855 WIRT L Rink RD CAlTI4NWA4183 <br /> RANCHO COROWA,CA U1,74- <br /> ad.U.S. <br /> 4i47ad.U.3.DOT Davidson gmlMuq Proper sell Nana,HaaN Class,ID Namur, 11I.ConWmm ItTaa1 12 Una 13.Wwb Calve <br /> NM mtl PaNrg C+aP%arty)) No. Typo Oventity seem, <br /> Ir K 1' R,],tN1aM3.WASTE PA$W REI ATF(T ANTERIAI 1 IaRll 1 11M 55 !i <br /> FUU3 W14 <br /> Oa <br /> do <br /> i 2. <br /> lM <br /> u <br /> 3. <br /> 11.ik,JHemtllrG lW5J-ls amM IA;N lI W lI <br /> EMLHLLNa'sbb5O U1 VA ill WA:JE I R(9p 11U <br /> tMl'ItiiENC;t'i:VNi At:! MIKE <br /> 15. GENERATORSOFFEROR'SCERTIFICANON: I mmaymmm bN be bananas minis mnaignment are nilly and acormmlytlesmbetl above by me proper slipping new,,at are GaaNfisid moaned, <br /> maysdand bmlatllpavrded.and are in all reapers in gopmboMNon fa4anspirtammtlirg toappiceba imemeso,alem mhmal gmearmenal mgulamna.If c ion aM1ipmeend I am ne Primary <br /> EapmNep l cerWy bat the ronmas minis mreigni ronann Iambs amsane aMMed EPA,r,emmleUgmentol Consent <br /> ImrNy matter masa namaralgn saamant remlifiea in b CFR 2B2.27(a)(fl am a babe quantity general lor(b)%I am a small quantity larmse lis We. <br /> GenmaymDaem's PbnaUgype!Name. Sgmanm Monb Day Year <br /> i <br /> F 1fi.InameAonal SM1lpmma ❑lediU3. Erymyroa . Pato(4nhyman: <br /> S Tramspaar aignatum lar expense dri Dideeanrg US.: <br /> z n.Tm rMtlmaaedbmemaRmWmMamtlw <br /> new t"me't ad Nam / 5 Monm Day Year <br /> X11 <br /> marMmar,mmetllTypetl Name Simule' - MmiM Oay Year <br /> 18.r Dnaep i 15e.genepr ylMibetlon span ❑ Oppnk ❑Type LJ Real El Played Hexed., ❑Fall Redeem. <br /> MammalRefmnro Number. <br /> 18b.Atlamaa Fal(or Gearamrl US.FPAIDNmber <br /> FameyU <br /> LL 10b.5 ePCMB: <br /> Q� 18c.sgnaWv afAamatB Faotlay(or Gemmta) Mmb Day Year <br /> 2 <br /> 19.Hadallous vymte Repan vanegemenl Matlmd codes(i.e.,take for havkwa eaN meera 1,Above,and m,em,symbmal <br /> c t 2 3. <br /> Notice:State of California requires <br /> generator to photocopy and mail to <br /> 4.Deagnaad Facile,Domer or Opemta CeyiMGmn of mvipi M haallous maenads avmed by line mantlmt eebapl as meed in lam tike USC W lads 30 days: <br /> Pnnadrrype l Name 3gnabue P.O BOX 400 <br /> Sacramento CA 95812-0400 <br /> EPA Form 8700-22(Rev.1217) Previous editions are obsolete. GENERATORS gill COPY <br />