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Oct.22. 2012 3:50PM <br />Please Print or typajor�dCsignedfor use dd 041002-pgcnl tyRewNteFl <br />No. 1110 P. 1 <br />Form ADarUVad. OMB No. 205D•0039 <br />EPA Form 87&22 (Rev, M5) Previous ed4ions are a_ solete. DESIQNATED FACILI TO GENERATOR <br />.UNIFORM HAZARDOUS' <br />1 Generator ID Number <br />1.C A' 7. 0 0 0'"� 6 9 3 7 5 <br />Page 101 <br />E e R Phod ': '— <br />an d. o nfiumaar <br />OOS8Z6929, JJK <br />WASTE MANIF T <br />5. GemeSeKNiQa.AndL� G <br />IVOAddroenaramos ts Site Addred diaerent than mailing address) ; <br />O7MMUONLRDp�R <br />CA 86200 <br />Geml n n ion r�� <br />nerators Pho': - 209,414CA9 <br />B. Transporter l Company N&16g�pp <br />U'C l�i Tie 2 8 2 7 '9 0 3 6 <br />AW,Y ENVIRONMENTAL SEM ACES la <br />7. Transporter Company Name U,S.EPAIDNufiber <br />B. h / ewsiSbAd469Q _ U.S. EPAID Number <br />gadN <br />. <br />M, N:NALLAF&DA STREry ET C.AT'0 8 0 0 13 3'8 Z <br />TON LAA 90722 <br />Fast 'a�Phonne�:.. 1910163%7100 <br />9a. <br />ab. U.S. DOT Description (ihout ing Proper Sh"Ing Name, Mazad Class, ID Number, <br />10. Conrelnare11. <br />Toler <br />12: List <br />13, Waste Codes <br />HM <br />end Paclmg Gm4(a any)) <br />No. Type' <br />CaarV4 <br />VAIM. <br />MON-RCRAHAZARDQUS WASTE: LIQUID (ORAE I LUID) <br />2 <br />DU <br />/VV <br />G <br />WEAM'ASBEEN <br />z <br />2. RHAHFIEB <br />FOR RECYCLINGITREATMENTATTHE <br />DeMENNO/KERDOON FACILITY IN COMPTON, <br />3, A. T IS FACT ITY HAS 1HE NECESSARY <br />PERMITS TO RECEIVE YOUR.WASTE STREAM AS <br />01 1ALIFIEU OUR ERA. NUMBER IS CUOMO= <br />4. <br />TT <br />14. Spacial Handlinglmauc5nmandAd6dond Ydismatlen "' - •" <br />W-ROENCY CONTACT: CHEWAEC 1 -9"A -O00 NAER(*901.111 "PROFiLE#981:2H1300OWE'F�_UID"Port <br />Al MAXI I a APPROPRIATE PERSONAL PROTECTIVE EQVPMFNT Y <br />lie &:5- <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare tiatlhe Mara offt edmlgnmem aro fully and amtitaley daWbad above by the propershipping name, and are daeeffed, packaged, <br />marked and labeledrplecarded, and aro In all respects In proper wndidw mraartapon aOooNling ro applicable Imama8arlal and na6mal govemmenml regulators. M airport shipment errd Ism the Primary <br />Exporter, I ceAl), thstthe cunterdsof Ihb consignment corm to the tens of the eb ohad EPAAcNnowfAmentofConaenl. <br />IceNy that The waste mlNmlzatm statement IderNed In 40 CFR 26227(e) (d I am a large quantity generamr) or (n) T am a small qui generator) Is we. <br />GVerato s1011erors PrMed(Typad N acrekith A" Y <br />18.1 am al 5hipmams <br />❑Imporlto U,3. I henW .. Pon of enay/exit <br />Transporter signature Tin exports only): - Dose leasing U.S.1 <br />Of <br />IT TmnspodarAdvmunaagmentofRacelpllofMMaatMas <br />R <br />H <br />T her 1 PdpwdlTyped !� G ,p. 91gnaNre <br />1•� C <br />y .. / <br />7, i3ic-i !ea <br />C <br />TrenepaAer2Pmle Name ftAmm Montll pee, Year <br />18.OisVepanq <br />1aa. Discrepancy lndlcadon Space ❑0"ty El Type 11 Residue ❑ Part,] Rejection ❑Fulkajem'm <br />Manifesl Reference Number. <br />18b,A mmale Facility (Or Garremlor) U.S. PPAID Number <br />U <br />Fadlih/sPMna: <br />BG SIgnaNra ofAAemde FadNy (or Denemmr) - <br />.Day Year <br />z <br />y 19.11aiardous waste RepmtMenegimmara Memel Codoa4a.; cases la hamdaaa vrosm trea4nenl, aepoem, mdiegWngaysmmc) - <br />20. Designated Fadly, Owner m Opntar. CenMmeon Ofredeipt of hdArdowi,61edals &Vined by Ile mangeM lotcagl as road l 1piri `. <br />Printed N.. -,., r <br />EPA Form 87&22 (Rev, M5) Previous ed4ions are a_ solete. DESIQNATED FACILI TO GENERATOR <br />