Laserfiche WebLink
Please PrInt or type. Form ed.OMB No,2050-0038 <br /> UNIFGRU RWRDGt1S 1.Denrerata ID Number 2.Pepe i of 3.Emeryancy Aeaporse Phamlin 3 N� rr� <br /> w C 6 VES <br /> WASTE MANIFEST o <br /> 5.Generarar'3 Name and MWIN Address Addreea(U*%"I than rnaling aftm) <br /> YL=SA GALVAN <br /> JFM LX a&OMD <br /> 5655 ER)OD WAY <br /> 11ZAGY CA 9S377-7217 <br /> Ganareto>ra Phone: <br /> s.Transporter 1 Company Name <br /> U.S.EPAID Number <br /> 1 JA p AT, 14 J D <br /> 7.Trenspater 2 Canpany Marna U.S.FPAIO Numbs€ <br /> TPATA7E KOMRMANHUM O I] 0 9 5 0 3 8 9 4 <br /> 8•Designated F"lty Name and Sk Address U.S.EPA ID Number <br /> VEMaE8lORClRQCAL$O1.J7l)DNS, <br /> L.L.C. <br /> 1704W FWT sir <br /> f'8011 's Phone; AZLIRA,CA 91702 <br /> C A D O <br /> 9a. fib.U.S.DOT Descd w(hxl 4N Proper Stpppinq Name,HOW(*M,ID Number, 1g.Contalrrers 11,TOW 12,Unk <br /> HM and Packing Group V any)) Qu13.Wavle Codes <br /> No. Type arrtdy WtNol• <br /> w 1 UNI 993,WASTBFLANMABLBll141 f1u� D401 <br /> (e"a Spa��'.PBIROIBOUPMUAA 3, �71ffi7Y�iTl� <br /> 1 DF 6 3 P 391 <br /> uJ ,x 2' FJNIM.WASH PLAMMPARLB <br /> (()-RYL W ZOPRWANOLI$.II F003 U057 W9 <br /> 1 D F jai P PROS M 59 212 <br /> X UN1196.WAg-.FO1EKALDmrim soum7 .amu& <br /> 3(8�B( D041 <br /> 1 L' F 20 P3J <br /> X( 4• LW3175,WAST13 SOLMS COMARMIUVLM&&BL]3 ir0O3 352 <br /> S�,nb•.(DPMM CONTAMWAM Wng <br /> VBuM 4.1.11 1 D F 4 7 3' DWIId.Spat Rand netru an dlons tnromratlon 1811 SMko GMUWW by VEM + CowW4 WhIloW by �� <br /> MOM <br /> AZMP93 2jERG 8 W-7�%5 :1bsftto 32 W. 3 A:A7;Cf ftmpoliM PSSt!►1 �133 We U 1.128 D�Nl1 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I herebydadaradrat#w wntents of itrte conslpmwnt are hdlyand awltatolydescdbed abomby Lire proper 3htpplag name,erd areclasaitied,paciceped, <br /> marked and labeladrINowded,and are In all roWcfs in proper carob n for transport amordirg to applicable InlernabW and na%W povemwtat rep jatwns,N axpaf shipment and 1 am dre P*rwy <br /> Exporter,I certify that the omlenla of!rile canslgrmrerlt wnfomr to the farms of the attached EPAAckraNWgrnent of Consent. <br /> Ice*that the waste minlmtzadal 3tatoment Identltied in 40 CFR 282.27(a)(M I am a iergs quandty para mlwl or(b)(If I am aura que"generator)Is true• <br /> Ganerato dOffeWs PdnWtyped Name <br /> Month Day Year <br /> LORRAIIriI]ORTA <br /> � 18•fntematfrnalSh is <br /> z ❑Import to U.S. El Export Gam U.S. Part of errtr/OA <br /> Transporter (for axporls only): <br /> bete leaYknp 71.5.: <br /> 17.TrarrsporterAdnm6dprna 9 o(Rocalptof Mat <br /> Transporter1PrtnlowlypedHama 8lpnahra Afanth Da <br /> Y Year <br /> 54NNY CRUSE <br /> poder 2 HI&Wypod Name 12 <br /> 8{nnalure . Month Day Year <br /> 1&.Otscrepency � Z"� <br /> 1804.CNsrneparxy Irdtcatlon span ❑Quandly ❑Type ❑Reelduo ❑Partial Rejection ❑Fu1 Rejerdlon <br /> Manifest Rererer>ce Number <br /> b <br /> l ,Altemale Faollity(a Generator) U,S•EPA ID Number <br /> U <br /> W Faddty'a Phone: <br /> 18c. Ipnatureof lemale Fedity aGenarakx) <br /> th Day Year <br /> 19.Hazardous Waste Report ManepayrtBnt Method Codes(€.e.,oodea for hazardous woole treatment,dwoea and gys ) <br /> © 1• 2. 3 4 <br /> 20.Designated Facillly Owner o€Qpomtcr,Cordlcadon of recetld of hazardars matedaq wined by doe menft except as qded in item 18a <br /> Ffintedlypedwarroo <br /> mmth Daly year <br /> E Form 870!}22(Rov. -17) Provious edlllons are obsolete. ! 210 Zf <br /> DESIGPlA1 E FA ILI PA's e-MANIFEST SYSTEM <br />