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a? <br /> Please nl or <br /> UNIFORM HA7ARDOUS f.ClawatorlD Number 2.Page 1 of 3. rm roved,OMB No.Zt]50 t)Q <br /> 39 <br /> WASTEAL <br /> WA Redponae ____Eon Humber <br /> 8.Osaaratofa dame and Ma>UngAddrese 0 0 . 7 9 419 4 VES <br /> _ y�A�, Ceneralw s SlfeAddreae�f dHlerent than malmv address) <br /> SUSBMDWAY SAAB <br /> € B.Tranapoder 1 Company U.S.EPA fD Number <br /> 7•Transporter z Company Nam* N J D 0 3 0 6 3 1 3 6 9 <br /> U.S.EPA IO <br /> RmT—B WO=TL4N II M Number <br /> 8.pesfgnated Peony Name and SlteAddrass M 0 D 0 9 3 0 3 8 9 9 B <br /> VBO AM' .ALSQW"4% Us.EPA ID Number <br /> L= <br /> 17%W.8>f8'[5n= F <br /> Fedll a Phone: AZi CA 91708 <br /> C A D 0 0 8 3 2 9 0 3 <br /> Up, Ob.U.S,DOT Dam#tbn Ondrrding Proper Shipping Name,Hazard Claes,II)Number, 10.cont aIn*ra <br /> HM and Pa*Q GOup Of any)) 11,Tinel 12.UnN 13.Waste Codes <br /> 1. No. Type Quathai, <br /> y m <br /> X �WAM FAINTREAM MATMA4 3,4 RQ pool. <br /> 2. I <br /> D M 1 9 6 >! 331 <br /> xUK19A WAff=KAJAMAM SAO" 057 VW DM <br /> 1 C F 31 B M9 DOOI 911 <br /> x s WDH. W_7'I3 g[A'I61��AN1' i)Ool <br /> WA'BX 5j, 1 C F 30 P 141 <br /> x 4' WABU �I�� <br /> Doo1 <br /> C F 77 F 791 <br /> 14.Spaolal angling Inebt ums <br /> i1�8*rio* tOrvS +4MiM.ay tt+w�on <br /> +�a� liriwyrrdrrid+YarOlii iliif 1 ltala�l— ��B 11idG MQLUW:7MOAr <br /> 1j19i �l1t6o1A:AS,1�1lS 3j14IlIV <br /> :7i31t3��4) ys <br /> 1S.' CENERATOR'SIOFFEROR'S CERTIFICATION;I herabydadare Ihat oorrlatlts of thio 1 ac ira dasalbed � the marked and fabeledrpfacm%jsd,and are In aM ra bl I shlP g name,and are ctau ted,padraged, <br /> Fxporesr,1 M"that the contents of this th Pry DandJ W for f the W �b aPpl IntemaGons and DdmW govemmanW(egulallons.0 O)W shipment and I am the Primary <br /> carmlprntent caatorm to Ore terms Of the attached£PAAdcngvAedgrn*nt of Consent. <br /> I oaztlfy that the waste mhhlzom statement Id9ntl8ad In 40 CFR 292r(a)(WI am a large quardtly generator)or(b)(ff I am a WM gdantity generator)is buo, <br /> Genera WO%MN PdnWI yped Name Sig on pay Yaer <br /> 16.Intsmatlorral3hlp nta <br /> ❑Import th U,S, ❑EVort from U.S. Port of entrylexit; <br /> Transporbaf OW&M(to*orta onlyl: <br /> 17,Tm mporterArdmowledgment of Rate leaving U.S,: <br /> Reoelptaf Mafedala <br /> Trarmportat 1 terYlyped Name Slgnatuie Month clay Year <br /> Dw Add <br /> Y* <br /> Month Day Year <br /> Nam <br /> 18. Isaeparwy <br /> 18a,Dlacreperwy IndkaBon Space ❑Quantlty ❑Type ❑Rosm, ❑Partfel R.J Wort ❑Fug ReJWW <br /> 18b.Ahemale F Mar"Reference Number. <br /> adllty(a O*nerata) U.S.EPA ID Nwnber <br /> LIC V <br /> Fad ws Phone; <br /> loc.Slgnatwe ofAkernate F or Generator <br /> Month nay Year <br /> 19.Hazardous Weare Report Management Msttgd Codes(is.codes for hazardous waste treatment,dleposal,and tams <br /> th8� ) <br /> 3. 4. <br /> 20,Deslpnated Facitly Owner or operator.Ce cation of receipt of hazardous materials covered by the manifest* Ba <br /> EPA Form 87 (T.1 z-1 7) vkwa edlUans are te. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />