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f <br /> PleaseprlFormAp roved..OMB No.20500039 I <br /> ttlar e. -"� �.: <br /> UNIFORM HAZARDOUS E.GaneretorIQNunlbar . anh, n ag udsso <br /> WASTE MANIFEST `V= :7 9 5-52-5 VES <br /> 5.Generolals Name and Melllag Address flenere.Wfs$110 AlItiream(I f 41RAlbfrl fltgJ1 104. eddr$ss) <br /> SIA GALV'AN <br /> YMEX�� SAWS <br /> MEMODWAY <br /> )RAM CA 95377•TA7 <br /> Gensrolor's Phone: <br /> B.Transporiar 1 Company Nams U.$.EPA 10 Number <br /> ns�VEOLIANS <br /> » J as <br /> 7.Transporter 2 Company Name .&EPA ID NOW <br /> MPSNVIZONMW1`ALBt CAT000a24247 <br /> B.Designated Facltily Name and SlleAddress�A3;$ U.S.EPA ID Number f <br /> 1704 W.FMT 9781k01T <br /> Faclhl s Phone: A C� 91702 C A D 0 0 9 3 6 2 9 a AI <br /> go. 3b.U.S.OOT Descdpllon(Including ProperShipplog Name,Hazard Class,It]Numbor, 10.Conlelnera Et.Total 12.Unft 13.Waste Lades <br /> HM and Pacfdng Group(it any)) No, lyps Rusn$ty Wt 2k <br /> X t' EU0014 WAS7EHYDROMINPE40XMB,AQtWW DOD) 791 � <br /> 9E511(BXII X <br /> 1 D v so D002 , <br /> X 2' ,DR[JN2 A W�ASn I[CALCKiP�U MpCI DOI <br /> 1 D F 10 P 141 ' <br /> X 3 20�r u,���W ACM <br /> � A IDO SUMEZ 1 <br /> ACIDX IL N 1 D F 1 10 P 701 r <br /> x MABTB C C $ <br /> DOD <br /> II�TUR 1a,o,�„, <br /> 1fl.&R 1 D 10 0 P 141 I <br /> . i <br /> 14.Special Handling Instrrro8ans and Addltlona4Information aSavilpeL l4Ctxcr�by V '1S.-I"C.ulalaA(tii"by ii <br /> X1"2 KRa W, bA.�sl t 154�1►:finS .A M 4) 1t i ;�i&3- All i <br /> , <br /> 16. GENERATORWOFFIRROW8 CERTIFICATION:)hereby doolore Utpl the WnWrils of(his oonslgnmantate fullyaad accura*dssbdbod.Above hythproper Ahlppl(hJ name,&rd sreclasallled,packaged, I <br /> marked and isbeledlplaeardad,and are in all respects in propercondldon for transpo€taccording toappil mb%Intemalbnalend gaemment <br /> 8onalgoval. u(ations,Itex*shipmanl and lam the Primacy r <br /> Expeller,l certify that the contante of 8tls wnslgament canferm to lha ierma of 8se atteclled EPAAlgknoyAedgmsntof Consent - - I <br /> I cer8fy That the waste minlmiza6an slalament[dan6ged In 40 GFR 282,2T(aJ(Iii am aiarge Auantlly genarator}.ar @)�I am aAme1J uantitygens is(rue. `• <br /> Generator'slOtferor`s Pdnted7yped N Month Day Year <br /> Uliss4 LU 1 1 1 e <br /> t .Inlemalfunal Shipments 0Import to U.S. ❑Export from U.S. Portof entrylaxlt: <br /> Transporter signature(forexports only): Dataleavfng U.S., t <br /> i7,Transporter"novdledgmenl of Racelptof Matedate t <br /> Transporter 1 Pdntedlrypod Name Sipa nth Day Year r <br /> a JE M�D�+I .10CURT ( 1 111 $ 12 1 <br /> to Transporter 2 Pdntedlfyped Name Sigoature Month' Day Year s <br /> r <br /> W.Ulsompancy <br /> 189,Discrepancy IndlcaBon Spacerr---tl �y f <br /> ❑ Ouendry Typo L..tRealdue L.JPa�la1-Re)scHan �FuIIReJedfon <br /> menifea!Relatgrice.Numbor. <br /> 18b.Allerrrele Fadlfly(at Generator) ti,S.5 AID. umber <br /> J <br /> V ' <br /> —LL- FadllVo Phone: t <br /> .W Bc.StgnotureofAllemateFaclllly(arGorarator onBt Day You <br /> a <br /> fl).Hazardous Waste Report Managemenlhlolhod Codes(i.e.,codes fgrhazardaus waste treatment,disposal,an+i rscyding systems) <br /> 1. 2. 3, 14 <br /> . <br /> ® 20,Desl paled Fadllly Owner at Operator.CorBflsatlon o ecolpl of hazardous materials o6vsred by Ilse manlfasl except said Iii a 1aa <br /> Mr, <br /> ped Name 5,tlatureay ar r <br /> 1 /P, <br /> A Form 8700.22(Rev. -17 Previa IUens ere a#sale e.. D)ErSICMATO FACILITY TO EPks e•MANIFEST SYSTEM <br />