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Oct. 22. 2012 1:35PM No. 1160 P. 4 <br />P)eas9yrint m . Form designed for use ee ali(o 12 wahal, I•, <br />UNIFORM HAZARDOUS 1 G000raw ID Number s: PaAetd 3. Re Form raved OMB No 2050-Ot <br />WASTE MANIFEST C' A R 0 G O. i V 9 p 7 I C"^?�°"? . 9pbnaePhonef 0.M/annNniThei umbar <br />5. GenerelI Name and Mailingpddress ` 42 IJ300 0095K607 JJK <br />M N PDLL #10 GBneretMs S@eAddrass (Ndirterent then malkngada gee) <br />if") BTGOKTON f1LWCA <br />11, 7D(p S f 1:KTf�n113LYG <br />SACNAAkN'Tii 9168844946 UA, 950f2d ^aAt;NAtv1EN'TO CA <br />Ganeretoda PAM : <br />6. Transporter 1 Cpmpally'Nema� � - <br />ASI EIUVIRUNNENTAl SE.Ri(1DEfi u.s. EPA Number. <br />T- Tronepo1ar2 Compelry Neste C A (1 <br />U.SEP7 (1 ;;t: <br />. A ID Mnnmr <br />8. Dmignaled Fadlay Name and Site Address. - <br />NhIvKIF EWlR0W4NtAL.SE'RvlIG U,& EPAID Num nd <br />1516 SOU I RIVER MALI <br />WESTSA(MAKMO CA �i691 <br />Fel ?a Pham (916137IV47 <br />9a. 9b. VS. DDT Deeglotlon (Including Proper Slipping Nesta; Huald Claw, b Nam 70, ConMlnero <br />SAM and Padang C*cw(dany)) 11. Total. 1Z ung. <br />sad <br />1. <br />No, TYpa Duenely YYVVd. waste Codes. <br />NCM-110RANA,.A IXIMWAafE "Il µ1&fei991LM%fDfill} 1 <br />2. tial TT <br />E <br />Atlditlmlal Momatlen <br />1fAEWt.11139: 171 `PRc>F7tE 11D12C►Efu) 11(3MNDYCLW7AQT CIiL{WIRF.GF�4121-@C1QU'AIN�1711>n(ALEpACCJi>XS: <br />X39 . N( "(UiPRC1PRiATE F? RSI lAL PROTECTIVE EOLURNENT <br />V <br />15. DENpackaged, <br />na <br />an la'SIGFFEfloR'S CERTIFICATIpNtl herebyGedere that ins gedepta pfihls wnsgnmemaro Nlryand eccuretery deawbed abore 4ytM.pmpmaNpdnA me,ab ere dawifiad, <br />markeded end laheledlplawrded, and era In ell le9pegja In proper wndltlon fm lronepoltaaording MeppOgMe Mlemidonal entl national am <br />Erporter,Ican" that the comenta of lids consignment mfoankgro farms Of the eryeched FPAgc gos' mentalidfuliall Ifarport shipment and lam fhb Primary <br />Iwily that amwaste minVmweonsWementMwtlgedh40C[oft 2T Hiemele a FA kmwadgmiCarl <br />IOl r9 q Sly 9enemi0r) or ) (91 em a small <br />,... quandg.ammor) 4ON,PantedRN elif 11 <br />,m <br />r"-i Year <br />� 16. International shipments <br />❑enpodlo D.S ? Eapod¢UPodL9nspdaer signature eVoitsmMy deneyle <br />�( <br />W 17.Tmwponw Adaw sdgmdttdRecapldMalE 'Date kevl11 V.S.i <br />a'Tronepor(a( 1MINWirped Named <br />Signal <br />4manDq' e9r <br />4K TrdnwoM1eof <br />r2 Pooled r}eme <br />SgnaNro <br />,r eioMn. Day Year <br />fB. DlsaeDanq <br />189. Discrepancy 'Indirabn Space <br />❑ tluanpy ❑Type ❑Reslaue ❑Poll Raladdh ❑Fug Rejadgn <br />18b. Anemem Fedlhy (or Generator) " MaA9AN Reromnm Number, <br />V u9, EPAID Number-, <br />LL Fadlllyre phone: <br />78c. igneWreofAlMmale Fadety(or Genelalm' .. <br />z .. wm .Day ear <br />ID <br />19.Hea±w Wwle Repod ManegelnetitMedloi Codes P.O., wdeaforhaninous waste UeaVeent, disposal, ane nocinerlif tams) <br />90, Daslgneted Fecgiry Owner Operator. CaNflmtlon df fatelpl dheYaMeus matedele covered M tins mangemexraptae rMed In Nem 18e <br />'�•ndnte Name <br />eN e <br />)?Man user <br />EPA Form 8700-22 (Rml. ) Previous ei i4ons are ODsdete. <br />GENERATOR'S INITIAL COPY <br />