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Please print or type. Form Approved.OMa No.2050,0039 <br /> UNIFORM NA2AR000$ 1'Ge'Ie2brlD Number 2.71 of 1 3.Emaryency Ronda. on 0.ManIM1CITrxXinB Number <br /> WASTE MANIFEST '_wtlnr ih -.! 0257:13067 JJK <br /> 5.General Name and Maling Mdreee Genera:ols Sire radio's MdAeadn"on.mantis domeam <br /> i)kI IP PA,A ll'f.i f tiiM%VdY <br /> t;l li Y:11 i1l.MAN ,p <br /> Gen«eNIS PM1ane'_ e <br /> Name U.S.EPA ID Number <br /> 6.TrampoMr t Company <br /> T.Tram mNr 2 Carl Mma U.S.EPA 10 Number <br /> 8.Dorian alea Fecal Name add Sao Address v US.EPA 10 Number <br /> r.MP MV..At iI'm Il 1.IN <br /> Faeft 'Fborx::14liJ:..i:LW ,a•.• •..• <br /> ga Mir U S,DOT Oe drollon(IncNdir,Proper Sbidan,Name.Hal Class.lO Number. 10.Comainard 11,Trial 12.Uah 13Wase Cotles <br /> HM and Paodrg Gaup(il any)) No. Tyne Oumety WINO. <br /> 1. <br /> O¢ <br /> C <br /> 2 2. <br /> 3. <br /> 4. <br /> 14,epadminendarommmon .nd MdlwaN InrdmaM1en <br /> roar <br /> tNi 'v Rn iH:.I rnTp <br /> 15. GENERATORWOFFEROR'SCERTIFICATION: I sandy marten Mal Ma onene of Me wmign...I are Nlly and awrably amoral Move by Me paper sMppllgnme,Mare deeelfietl,p olossa, <br /> marked ana doeledsAnoomed,am era in all reapede.proper-dl Vandal a««ding to epoioabe immnddonalard nations ads,"a nrel Monsons.IrexponshigmrllanJ lam Me PMaary <br /> Examen,I cortf,Nat Me c nlen6 d Ma arraignment moon N Me reams of as apstll�EPAAdnmMedgm«d of commit <br /> I wally Mat ee wase mM orroodpn affemenl itlmtlfied M 49 CFR 262.27N)(it I am a lai quanliy,gmmaen)«(b)(ifl am a mall mal geniaanarl a We. <br /> GenararWLORemis Primedl Nam. Sandal MorM DaY Year <br /> 16.InemaaaNl SM1lpmmM1 ❑Impod to US. ❑EraaNb«nUS. PmofmbyRail'. <br /> iTnnepmer ai9nei(for eapods only)'. D"1.0,U.S.: <br /> rNorthC 17.Tonapod«AdrwMM9mml M Remipl of Maknls <br /> allorthOay Year <br /> Trmepdier 1 Pdn6.rdRyaed Nana SIMM <br /> O <br /> ai Trerapoaer2PdntetlRYPetl Name 519raNre' - Monts NY Year <br /> K <br /> H <br /> i15.DsaepmcY <br /> 1aa.Deoepenrylntlkatlon Spam ❑ Orgy ❑Type Ll Real ❑Paha ft colon ❑Fooremectlon <br /> MaNlesl ReM1rence Number. <br /> tc <br /> 186,Memee Fadllty(«GeneoloO U.S.EPAID Number <br /> U <br /> aQi FeWiy9Phas: <br /> w 1&.SlpneNaeIMemae FadMp(«Seasonal) Monts Oay Year <br /> I <br /> Z <br /> a19.Mai Wase Ream ManagementMMbm Codes(i.e.,aroma l«bavatlous were treatment.deposal,and motoring systems) <br /> Wo 1. 2 3. Notice:State of CaliforniandQMail to <br /> generator to photocopy <br /> N.oespnaetl FarJlity Wnerpropmanar:CmeBoal ofrad ipl ol6essaoos materials wvere!by Me merabteadeptas odea In Item life DTSC with 30 days: <br /> Pdnb—yped ame signaare <br /> P.o Box aoo <br /> sacrarne l CA 95512-0400 ' <br /> EPA Farm 8700-22(Rev.12-17) Previous editions ere obsdele. GENERATOR'S INITIAL COPY <br />