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<br />FcmlADIxcved. OMB No. 20504039
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<br />UNIFORM HAZARDOUS
<br />WASTE &imam ,
<br />I.GfDNuer
<br />C031864
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<br />kfrrnargancy Rasparsa Phone
<br />774564265
<br />4 Idenbet Owddno Narnhor
<br />021360751 JJK
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<br />& Generator's Nenteimd Maoo Address _ • - • i - . Gendratereeektdresi (I dIfferard than malting address) Gad 1.••••••.,..- RaMod Mks Dtfidon
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<br />,GenerateSPhOra M43743700
<br />6. hansporter 1 Oar:many Name . . . . •.. . „ • . . • . UAL !TA ID Number t
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<br />Ponder Entronmentril SfliViO2S '• ' 'CAdl0001 00737
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<br />T. Transporter 2 Company Name . • U.& &AID Number
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<br />& =a.m.- Site Addr!ss ..
<br />: U.S. EPA ID Numbor • %. .
<br />2000 Pi. Afan2=t • ••.:.• . • • ...
<br />Compton, CA 902ZZ . . ., • .V..-
<br />-310437-7101 -- I Farah . , Phdaer: •V . CA10.00;111012‘ • •
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<br />IS. GENERATOR810RM= DEEM:MON: I hereby declare that the contents dents ecrosIgnment ere hely end mast* described tame by the proper stepping name, ard aro dessided, pada6ed.
<br />clerked and lebeted/pkwarded, anttere In ea respech tn wiper =eon for transact moo:ding tali:cake* trlaratonaland national govenanentel remdallore. II wort shIpmenl rmd lain the Przonary
<br />Erporter, I certify that the contents of Ws consIgnmerd =dorm to Ole terms el the attached EPAPainoMetment Consent -
<br />- I certify UV te statement Vended to 4r) CFR 2622/(a) Of I, am a tube •• ,• 4% ii:-Llv • a (b) (if a shwa •• •: ir •• genemtor) Is tam, i
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<br />184 Vigo= of kernabo Faceity (or Generator) V' .
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<br />Month Day Year
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<br />Hazardous Mate Report Management Method Codes (Le., oxles for harrodota waste treatment disposed. eral rags:Ong eystens)
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<br />1102 q
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<br />DesIgnated Feollly Comer or Operatic Certfeeden of receipt al hazardous materials cowered by the modest eszept as In Iteeklea •
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<br />EPA Farm 8700.22 (Rev. 12-17) Previous ettione are obsolete.
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