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Pleeso nt or Form Awovei OMB No.MW.O ss <br /> UNIFORM HAZARDOUS 1•Generator ID Number 2,papa 1 of 9.Fmetgert0y Reapatee Phone sratl�taq N <br /> WASTE IIAINFEST AMO 0 Q 662 4 7 Z O v {� VES <br /> 5,Genereloee Name slid Ma ft Addree6 YIri 411 t vMr Gmerator o-%Address Qf d@fererd%w n"V address) <br /> Mg D WAYZAI)t11� <br /> c?ens p"A%"?M7 <br /> 6,Transporter 1 Compargr Nems U.S.EPA ID Number <br /> YBWJAEI TH0131 u>zr eC== Iv t n 0 0 v 0 <br /> Y.TreasporW2 Company Nemo U,5.EPAID Number <br /> AUMD=T W'C0. IM0 D 0 0 3 0 3 1 0 9 a <br /> s.Oeatgnatad Fadlity Name and SltaAddrun UA EPA1D Number <br /> LLQ.. <br /> 1704W. YiiaGaL <br /> Fad s Ph": jM SUngill AZt1iLk CA 017f IC A D 0 0 9 9 0 1 0 a 3 <br /> 8a. 86.U.S.D0T0asatp6un(hck Nrq Proper ShoArg Name,Hererd Clea,ID Nw", 1g•Conbektera 11.Total V.Unit 13.We*Codas <br /> HM and Parldng G=P(t-y)) & No. Type Quantlly WUVDI. <br /> ce X 1.UnOa WMTB PAWT it1I1,A'(W 3dAZRWo 3a IIs V <br /> to <br /> X z. 0-RY[ <br /> 1 D M 215 P > 1,113q lfat <br /> x 3'IM175,WASM SOUM C WI'A2WW PEA MMU nm <br /> � fnl�CMAWUMW= <br /> X a LiTY M � 3y00f <br /> (I'3A'li Y 3.1. 1 I7 P 197 1• 141 <br /> 14.Spedal Handling natrtrehlorts and AdMond Inbmsdon <br /> Z=MVHWD'1UW.M604AAZLMM 3)EEM VM3qAtAZLjTA0now/L* 4�03VFIZWONN' <br /> AZli <br /> 15. GENERATOR'tt{OFFEROR'$CIDtTIFICATION:I hereby declare that the oonterda of Ne cortelgrmertt are fully and acmtety desalted aboye byt4 proper ehippN name,ant are dwsmod,pwwgod, <br /> marked and tabebNplacardrtd,and era Nt el mepecta h proper 0onditlon br trarreport aoCordirp�applcable kttemadorral and rtaYmat go+remmentat ratlorre.if axpal atdprnenl and I am the Prinery <br /> 600(tw,I oenfly that"aontents of 06 oorrelQQMW a nbm to the terms of the mmched FPA wt1 of corteenl. <br /> I c&*that she waste minNnlaWn statement Idon&d In aO CFR 252.2r(a)(t I am a lane vuwtgy generator)or(61 of am a small grmntlty generator)is kw. <br /> G'IVoeafohm6 PrinWTyped Name natue Month Day Year <br /> I�S� fr1 V I+Y\/ <br /> . 4 18,Intematortel Sh El Import ta U.S. <br /> ❑Ew from U.S. Pod of enuywt, <br /> $ Tramporfer dgrvuro(for exports o*y Data kravhg U.S.: <br /> 17.TransporterAdurovAadgmantorRe*ofMaiadals , <br /> rer;spoiler t Printed/Typad Name Slpnatura Montt Day Year <br /> Tr sporlar2 g <br /> � <br /> M �a Yaer <br /> /V5 <br /> 16. so oncy <br /> 18a.Otsrnapanty lldlOatNtn Space ❑ [Arently 0 Type ❑Residue El Parfet ReJed. El Fal Rejection <br /> Menlfasl RerarertceNuff6w <br /> teh.Alremate Fadlity(or Generator) U S. ID tAahhbar <br /> � I <br /> U. FadWs Pttow <br /> 1tic.Slgnatixe aMwrwb Facgly(or Generatal Day Year <br /> H ` <br /> 19.Harardoue Waata Report Managemerrt Magmd Codee p.,cndea for fuhul tra Wada Nealrwt dlap06at,and rogft syetama) <br /> t' 2. I'- <br /> 4. <br /> • t <br /> 20.llartlpnoted FadRy Owner or OperaW' toz <br /> n of of harardoue mabsrlale covered by the mmtleat qx2e a Itamdea <br /> n Name It <br /> EPA Form 87 22(by,i2-17IPkv&s edltons are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />