|
Please prril or iARNO 2050-003i
<br />UNIFORM HAZARDOUS
<br />WASTE MANIFEST
<br />I Generator ID Number
<br />CAL000447407
<br />2 Page 151
<br />1
<br />3 Emergency Response Phone
<br />877-2564263
<br />4. Man est Tracking umber
<br />0 2 3 4 0 7 8 1 6 JJK
<br />5 Gene toes Name and Maang Address
<br />W Csimperw Ire
<br />*dem CA , i
<br />Generatoes Phone
<br />AA
<br />Generator's Site Address Of drfferent than mailing address)
<br />6 Transporter 1 Company Name U S EPA ID Number
<br />Per411. OWIFWIlleriti SIMI= CA1110001110 737
<br />7 Transporter 2 Company Name U.S EPA ID Number ,
<br />8 Designated Facility Name _ ,,U.S,E).,A a? R.en,r, „
<br />Address `...•...N.'s.:,c•. ',..\ \
<br />(:5 1:'''''-'' r"fri ?Way H4,;$5,, 11 Wales Siuth of ZatV
<br />UwAY, 144: 0303 Faolity's VVT 3 3 0 0 1 0 0 0 Q Phone G. -Z39-4943 I
<br />9a 9b U S DOT Descnpbon (including Proper Shipping Name, Hazard Crass. ID Number, 10 Containers 11. RAW 12 Unit 13 Waste Codes
<br />HM and Raciong Group (if any)) No Type Quantity W1.11/01
<br />tr 1 Non4101,* biamirdota Weft Sold 6411 6 locks Cent* DM P 18
<br />.....1-
<br />c2
<br />w
<br />oininstod millh Sutrdc Add) 0
<br />Z
<br />11J
<br />C.7
<br />14 Spectil Hanglarg Instructions and Additional Information
<br />1) MEIN 0701 283804 S211 noon° =
<br />784380 /Alkit -r( J ( tl. O' •-4 S'q e2
<br />15 GENERATOR'S/OFFEN:MIS CERTIFICATION: I hereby declare lhat the carbine 01 041 consignment air fully am:ilia:anal dumbed abom by es wooer srepreng name. ell an Ciasealettl, paotaynd
<br />marked and labeteOptacarded, and are in el respects in proper COnditiOn for itanapOrt according to applicable International and national govermiental repulabona despoil shipment ere I urn ne PrPlary
<br />Exporter. I candy that the contents of this oonsignment conform to the terms of the attached EPA Acknowledgment of Consent
<br />I certify that the waste minimizason statement identrfted m 40 CFR 26227(a) (II am a large quantity generator) or(b) (ill are a small quantity generaiorl s two.
<br />GeneratoesOfferoes PnntediTyped Name Spnature Month Day
<br />1 0 5 I 0 9 1 Z 3
<br />,..., 16 International Shipments El Import to U.S El Expod from US Port of entry/ent.
<br />I—
<br />. Transporter signature (fa exports ally). Date leswig U S
<br />cc 17 Tran porter Acknowledgment of Receipt of Materials
<br />111
<br />cL
<br />0 0.
<br />I--
<br />
<br />"Tra9sr5er 1 PnntelTyped Name . Month Day yes
<br />WI 0 in OLCIL
<br />.... I 3 1 9 123
<br />(1
<br />g
<br />Transporter 2 Pnn rTyped Name -
<br />&endure
<br />1 ' , Monti Day yez
<br />4.--• ...-- -.cit.,/ -.a/WM Ai ..s....0 LI" 1./., 1 -xf' ....
<br />1 18 Dscrepancy
<br />18a DscrepancY Indication SFace In Ouaraty III Type 111 Residue
<br />Manifest Reference Number
<br />111 Partial R Uethcbon Full Newman
<br />17-r-
<br />< i.s.
<br />US EPA ID Numbe.
<br />18b Alternate reality for Generator)
<br />Facility's Phone
<br />Mongt . , ye,
<br />° Liz
<br />I.-
<br />I bc Spnature of Alternate Facility (tA Generator)
<br />- , , ..... ,-- r ... ,--- , ,, ,,,,,,,,, ' • " ' ' ' 'k ' ',. . -.,:,....• \ -,
<br />Codes II. codes for hazardous am* treatment. disposal. and recycling systems)
<br />° 19 Hazardous Wails Report Management Method .
<br />Fissai i 2
<br />lAta
<br />3
<br />by the manifest In kern r fraLaidums imilyqais meow exceol as nded 18a
<br />20 nated Facerty Gamer or a .. Mot Coot w . . ,
<br />1
<br />PI inteeryped ame
<br />nature S.. niririll
<br />4 11111
<br />al An_91 iRe 1 17 • V1OUS • lions - re .. i ' oFsin NATFII Fliril I TO t1FN n
|