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Plaase�pmt or tyw , Form Awoved.t)kIB Na.M40 <br /> UNIFUM HAZMMUS t.Gawrlor ID Nrmbar 2.Fhpe 1 of 3.F�nerpancy Reeponss PHans 4 <br /> WME UMFi~ST o VES <br /> a,r3eneretore Neme and I&EVAdftee �r a +h.,mel6p address) <br /> FBD IDc t�totII+ID YUUSSA GALVAN <br /> sHOW WAY SAWus <br /> ' ,r%x'777217 <br /> 8. mrropaler 1 CompmyU.S.EPA D Number <br /> AmLnxm 7.Tmnsportar 2 t�mrpsny iVame N 7 <br /> U,S-EMIL)NUMbW <br /> BRINIMMEMMME—cixM 0 D 0 9 5 0 3 II 9 0 8 <br /> 8. <br /> U94nalled Fodlily Nems end Sts revs U.8.1cPA IR Number <br /> }7041.PMTS <br /> Fo4l es Pfwns: Am ALBA.CA 91M <br /> G A D 0 0 8 3 0 <br /> 8s, 8b.U.B.POT ResuWw{Adro Proper B1rl OQ Nemo,Hax W Gap,ID Nunbsr, 10.CarGkstrs <br /> HM end Ps*V GmW(Hsny)) + 11.Total 12.UNt 18,Yft*Cadee <br /> No. Type patty WtNol. <br /> X YJA19D%WARM FLAMY*= .t1.164r FM w57 U239 <br /> PMRIlX ZMM"ANMs. <br /> 1 D F 185 r VW MID 212 <br /> W x 7. MPA WAMFLAWAKX <br /> ro-,X111M 1143111WAIM P003 um u239 <br /> 1 D 110 230 P FWS M59 2J1 <br /> x 3. XMI74 WARIM SOM CON AIIdIl+li3 PLAh"W$ FC03 <br /> 39 <br /> 2 A F 369 r mqi <br /> x UNM4,WAFM CORROOMIM AC>'titrr, <br /> waum s ou.Ql� IIM lyoo� <br /> 9t7i�►A'1 f�s. t C F 23 r 791 <br /> f . I $!$r13oe 1rY1r$1 18 + C�hfol �r�c Comm <br /> (MM Ml igrddmodn lIlbo bit a���+�1]U SLUV.71W4AI <br /> _)�1n W71 A Aa M X138 W:71s4fI s� 4)k" 54 W:71303 A;AZ[BrKffA <br /> f8. GENERA10R'SfOFFERORIS ClERMr.A71ON; l trereby dedans Ihatthe b atthio cor�ignmentare tuty and aoawaletydesulbed ebmee.by d>a proper eNppgq name,and dasenled,w d, <br /> marked and labeledfpleaerded,a+,d�In a>!reapecb In proper oondtdon for transport aoeordby m �intemauanel and rudWnW yoverrs�nerdal reguletloru.if e,�art� <br /> EKporie,I terrify that the conienb of lNs canslpnrwd conform b the terms of the ailadwd FA4AdagMMdp�tenl d Content. t and!em the prlmaryr <br /> I oerfNy that the waste mhlrlYzatloa itatenwnt lderdi8ed IM0 CFR zt+2z7la�{K I am s tart's quantity gerterokrr)a(b}(tf I am a srnpll grweity generator)b iva. <br /> C,erer+mtorelNWe Prbdedrryped Name g mw* Day <br /> ISA $ <br /> tb <br /> ❑Import to U.S. ❑ExpW hm U,B. Port otabylexlr <br /> TranaporW elpnahn{fae>WW only): Date bavlrp U.S.' <br /> f>: 11.Tranapo WAdmowlebmentof Receipt of Mate»tab <br /> TmnsWW I PWOWTypod Hama Moat, Day Vew <br /> O 412 0 1 <br /> T <br /> yaw <br /> DMvWKy <br /> t8a.Dltaeperwy b>dicalion Space ❑ ❑Typs ❑Rea(due ❑PIN Ra)ec0on ❑Full Re}ectlorr <br /> 18b.Altomato Fadly(a G&wabr) <br /> U.B.EPAIQ NarTrter <br /> Fadltlyb Ptwr>e: <br /> 180.tivnpw olAftemula Feo9ty a ) yaw <br /> 19.Harn(dous Wae,e Repot Iftegemem Mom Codas w <br /> (Is.,codes W tuvardaus neb haafrnen b <br /> t,d iepoeel,and recyc#rq ayabras) <br /> C3 1' T— <br /> ' ,� <br /> 4 I <br /> 20.Deslprated Pacify Owrrar a Opev.br d reoept of tardax materiels covered by ria nrardleat at 16am 180 <br /> �C <br /> EPA Fom 8M:U v.i -17) viou0 edltinoe ara olrsatete, DESIG [ED FACILITY TO EPA's O•MANIFEST SYSTEM <br />