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Plea f hr Form AWov0d,OMB Na,205W39 <br /> r <br /> IN Or ID Number 2 Pape iof 3.Erne gwq Response Phone1 nTfi 11ANlFE$T8 1G�7WO Nerve end Maung Address Generatofa 8lle (K ntthen Mitig address) 11X ES[OL1NDY111SSA01av NnDDWAYBA>6H <br /> & R%?'7.UJ7 <br /> derU.S.EPAIDNumber <br /> NJD- 09063 1rter 2 Companny Name <br /> U.S.EPA D Number <br /> A!T—ATEhfMVAWMTM trE O D .b 4 S 0 3 8 4 4 $ <br /> 8.Dssfgnsted F ly Name and alleAddress U.s.EPA ID Number <br /> 1701 W.FMTSIRM <br /> Faclll a Phvne; 17 AZUR,CA 91702 A D0 0 $ 3 0 2 <br /> Ba. 9b.U.S.DOT Description(Indudlrrg ProperShlpft Name,Harvard Class,ID Number 10.GonlsYreas <br /> HM end Paddng Group(if sny)) 11,TOW 12.Unit 13.Waste Codes <br /> N0. Type Quank NJVN. <br /> 1. <br /> r <br /> UIQ1963,WASM PA11r1TM ATED MA'1BRW,36 73,RQ D001 <br /> (DOQI) <br /> 2 1 1) F 71 P 391 <br /> X LWMKAMMffiKR SAL, UQ" Uig DO" <br /> 1 D M 1 8 7 P W39 . D001 211 <br /> x 3' UM175,WAMM SOLU;CONTAIIQ1NG PLAmmAm Ppg3 ls� <br /> AUaAr,, CMffAMWA�WnK <br /> X 4,1,R 1 D F 44 P 3'1001 <br /> "' <br /> x X1414 WA67sMMROa®+tFUCIMBANDPAW"ACB BICC DOb3 O002 <br /> ACRD ibRiEC RAW=),S.1(#XII <br /> 1 C P 60 P DWI 741 <br /> 14.5 al HarWinglnakiailonsandAddltlanetlnforma8on brVEM I Guam <br /> IMI 11�Itii11gI1 INP ip li+�Pf taY�Mllllf111 MII �1wt } j 1 1$�1:7I & <br /> 2)1111 198 7ltbbi A:AI:Ifi�iCt 3)1 133 W�• 151t ) 1410W:71SW A- <br /> AZURMI <br /> 15, f3ENERATOR'Sll?FFEROR'8 CF,R11F1CATION:t hereby rkdare tlwt the oontenfa of lhfs coneipmrenl ora tukyr end ecwrraialy deaalbed sDove 6y the proQeF aNpphp name.aryl ars dassHled.paokaped, <br /> medced and kbeledlplacarded,andare h NI respsds hproper condtdon lcr transport a0cwdlrp to sppHoable htema8wrel end nstlalal goverrrrrentel repula0orrs.ff export aitlprnentend i am Bre Nrimsry <br /> r I certify that the contents of Ode consignimni conform to the leans of the attached EPAA0Aowle;lgmeM of Consent <br /> I ceraty that the waeis minknlzallan statement IdenonW In 40 CFR 2lSi 2T(s)(!f l am a carpe quenthy genamta)or(b)(Ki am a smstl qusntHy generator)in bw. <br /> Gene tor'slMroe PrintadMAW Nameftne" mom Day ear <br /> 8. ntematlanet fpmants <br /> Transporter signature(far exports only import h U.B. ❑Fxpor!from U.S. Date feavkgPad of lU.S.: <br /> 17.TransporterAduwalsdgment of Receipt of MaterWo <br /> TransWgr7prERTyped Name Month Day Year <br /> imam Q <br /> Transporter2 Pdn Nam S1gna MUM Day Year <br /> G V17 T <br /> 18.Dlawepancy <br /> 18a.Dlsaepsncy tmlcatton Space ❑ quaff ❑Type ❑Residue ❑Po a Rejecllon ❑Fup Re) 0o, <br /> WNW Reference Number, <br /> 1 Bb.Alternate F"ty(or Genera(or) U.S.EPA ID Number <br /> Fedlllys Ph.*; <br /> 18c.Signature ofAltemale Faddy(wGenerator) Akrrlh Day Year <br /> 19.H!azous Weals Report Menagemonl t+AeOW Codes(Is„acdee fw ha A*w weals keaknent,disposal,and recydkg systems) <br /> i. 2. 3, 4, <br /> 20.Dasfgnated F #y Owner or Operator:Ce of recut of hazardcua matedats covered by the manKest ex llsm lea <br /> priniT ay <br /> i!A <br /> EPA Form 700- (Ro 12-17) It€ors i V.DESIGNATED FACILITY TO EPA's e•MANIFEST SYSTEM <br />