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Please pint or type. <br /> UNIFORM 14AZARDOUS f,Generator iD NumberForm Approval1,OMB Na.2D50 0039 <br /> 2.Page f of 3.Emergerwy Response Phone "nut Trecidnp Number <br /> tWASTE MANIFEST 0 01?9 4 3 VES <br /> .Genera:ora Name and MelUrrg Address alum <br /> YI3LWA MWAN Generelora SfEa #dlfetent lien meukrg accreta} <br /> FSD SX{111AIIND <br /> 5655 now WAY <br /> ref neje oYr1 A 1131M7217 <br /> 6,Tmnaporter 1 company ' <br /> U.S.E A ID Number <br /> 7,Transporter 2 Company Name D 1 <br /> 7ftrqV.tL MA ID Number <br /> : <br /> lIty Nara and NW Addrasa M 0 D 0 4 5 0 3 A 0 0 a <br /> �jAB8�.a�e U.S.EPA ID Number <br /> LLC. <br /> >ttiaw�rsn�r <br /> 34 AZUK CA 9170$ <br /> T DeaaWM(kr Gluding ProperS i ftName,HazardCiass,IDNumber, C 0 S3 Z . 03 <br /> g Group(ff any)) 10,con�Yrert if.Tote) f2.UnIil <br /> No. Quentily Wtivol. 13.Waste Codes <br /> ,WAs PAINTM AUD MAMiA. V.ir,Q DOq! <br /> CDAll D M 15 tS 1! 331 <br /> x z. UN1 AWASM�2�.� <br /> �ala�arrAr �n U07 [739 �00.i <br /> 1 DU a ! 1 p U1l9 . n©a1 ZIP <br /> x 3' M47P.WAM a ll)O o som,,.,o.�.. <br /> 4 I c F e P 141 <br /> X • cn�rl�U colAwn <br /> nam <br /> 14.ipedai andilnOl and Add fn <br /> t5. GENERATDA'SIOFFER�OX4ls6tlwW_11614AA1ar�DM =ftj*V ,s190Ae. f=AA 1 4)UQ154�1Q6=AAZUM <br /> V=15- <br /> RS <br /> CERTIFICATION:Thereby declare that the contents of ft comment are*and somwataiy deacrtbed above b <br /> marked and labeled7plaoanled,and are h5 di respects in proper oondidon far trensport acoadkrg to eppikable lntemational and natiorW Y a ahgpping name,and era daa m the packaged, <br /> Expotle,I cerUfy that the oontents 01 ttds coAmrent conform 10 the farms of the attached EPA g01 n��N expdrt shtpraent end I am the Primary <br /> I aef%that the waste mkrknlrAtbn statement IdenMW in 40 CFR 262.27(a)(If I am a Atygene figment � <br /> ( Iarye quantky generator)or(a)(If I em a arced quantity gersBrakx Is wa. <br /> Generalort! s PdnfedlTyped Name Sin <br /> 1 Month Day Year <br /> rV1 ZA. <br /> 8.Iniemattonal Shtpmentt aai�� ovltA <br /> ❑Import to U.S. <br /> Transporter signature(for exports only): from U.S. Pod of ant 0)dt <br /> 17.Trer*gPartarAdarawledgmantof Rem oitstatertais Date laavtng U.S.: <br /> Transporter 1 Printad/lypert Name <br /> AbnUr Day Year <br /> ranS r 2 Print yped <br /> Month Day Year <br /> 16.Dlsaepanry 122 1,2 1 <br /> 168.Dlsaepancy tndlcatlon Space ❑QuenUyType ❑Rwd. ❑Persist Re)edlon ❑Ful Re)ecgon <br /> 18b,Alternate FeWy(or Genera(w) ManUeat Retarerx:a Number <br /> US. AIDNumber <br /> V <br /> U- FadIV3 Phone: <br /> 18c.Slgnaturs o Iairww Faculty(or Generator} <br /> Month Day Year <br /> 19.Hazardous Waste Report Manegemant Method Codes(I,a.,codes for hazardous waste treatment disposal,and raoydhfg system) <br /> 1. 2' 3. 4. <br /> 20.Deslg tad F ty t]wnerar Operal9or CerUftca race3pt o1 materials oovared by the mandset except as !n Item 1@a <br /> Nn ams <br /> e <br /> ay ear <br /> EPAForm 870x22dons ere obsolete. ESIGN43ED FA L 0 EPA's e.MANIFEST SYSTEM <br />