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Oct.22. 2012 1,37PM No. 1160 P. 9 <br />Please print or toe. (Farm deslaned ier uo�. 112AmnuM,,.n . <br />GENERATOR'S INITIAL COPY <br />UNIFORM HA2AR000S 1.Generet-I0)Numbor P...1of ry�pyc�R phone• <br />WASTE C A 6 0 0 0 2 6 9 3 7 5 <br />Form roved OMB No. 2050-0039 <br />q. Mended Tn g um6or <br />MANIFEST <br />GenarakfaNema <br />(� <br />00$$7.6 <br />96 JJK <br />D. end Mallhggd�ap3.����� <br />V110�N�IfLLA1.I1QDIyIVN{VT(ERS STOC TON LLC Ganammirs site Address (If difnk man maolrg address) <br />VW7 CLARK DR <br />MIMTMI CA PhW <br />Genereter3phoo6: X9 4w, <br />6. TrenaporterlComparry Nama <br />ASt1VDRY F NVIRONA+ENTAI, i;ER41CF6 <br />u.S.EPAI Nu bar <br />r <br />7. Trenaporlar 2 Company amo <br />us. EPA 10 Number <br />B. Decignmed Fadlly Name and SilePddmse <br />HANGS EWRON` rfAL SERVICES <br />1a1S60L1 if7I (� HJAD. <br />Us. EPAID Num er <br />rt <br />WE6/SA(1 TO CA 06N1 <br />C 1) <br />," r <br />Fade siphons: X181. 1•�%i� <br />A D 4 4 0 <br />0 3 <br />- <br />9a. <br />9b, U.S. DOTDesdiptrnn (Irtdudtg lmW Shipping Nemo, Hazard Class, m Number, <br />10. Gmtainere <br />HM <br />erd Padirg Group (deny)) <br />11. Tolel <br />Ouenlay, <br />12. Una <br />NANO. <br />13. Wants Cerise ' <br />No. <br />Type <br />1. <br />N04RCRA HA7 DOHS WAM, LIQUID WSW OALMINEO 01 L. <br />001 <br />"f x <br />7 51:0 <br />C, <br />a <br />W <br />L. <br />/ <br />C0 <br />3. <br />d. <br />14. Spedel Hendlyg InsWctiera andAdddlonal Information <br />NAER04 091: 171 *PROFILE 9991: 110111 ENEROEWY CONTACT, CHENREC 000.424-M "ADDITIONAL FPAt COWl <br />901: , NONE • APPROPRIATE PERSONIII PROTECTIVE EOUPKNT <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION! Iherebydodarethat the mnlanls of this oorelgnmaM are 1.87 and accurately described aborti by paper shipping nemq, and art dBadtied, packaged, <br />marked and lebaledlplemrded, and are in all me" in proper condlNbn for banWertacmrdlrg w applicable intemnNamlend tretlgnal governmental ragWadom. If r pm <br />Exporter,1wrVy'hat the Ped shipment and lam the Primary <br />o"'ki Of this mn'01"18M mnfam to Ste terms order attached EPAAcknowedgmenl of Consent. <br />I ceray (hat the Wade Mnimaabon etalemem Henlalad In 40 CFR 262.27(x) (d l am a large quentiy generator) or(b) (Ill am a small quanbry generator) is true. <br />Genera efORerors PAMefVryped Name Sigmture 4' <br />Month Day Year <br />::4 <br />z <br />16. International Shipmentsrf'' <br />claportlo U.s. ❑Export Rom US. Pon <br />— <br />of enbyloxd' <br />- Transporur signature (for eVoononl : - bate leaving U.S.; <br />w <br />17, TransporterAcknowtedgment of Re81eIp1o1Ma1Bdels <br />C5 <br />Transported PrsdairPyypad Nemd <br />gnahae <br />4) <br />Monty <br />QTranSponer <br />i. <br />... <br />bay Peer <br />ntedriyped Nam <br />SlgnaNre <br />MbhM. Day Year <br />of <br />is Discrepancy <br />lbs. Discrepancy Indication Space ❑ Ouantiry, ❑ TYPO ❑Residue <br />❑Pargal ReJx5on <br />❑Full Rejeciim <br />Alanlfeel Reforomm Number. <br />10th. Allemala Facility(or GmaraloU <br />U.S.EPAI)NUmher <br />U <br />LL <br />FaciNty's Phone - <br />w <br />1tic. Sgnature orAltemate Fedlly (a GaneMta <br />a <br />Mona Day ear <br />a <br />N18.Ha;ardoos <br />- <br />Waste Repon Mahagooli Method GodaaQ.9., Codes for haigdousasks treatment disposal, and recycling systema) <br />p <br />1^ 2. J. <br />4. <br />_ <br />I. <br />20. Desigerfed Fedliy D,mar er Operato, q'the man8esl except as Mad In Item 10a <br />1 <br />PdntoofTypod Name 6ignaMe <br />on -0.yy", <br />EPA <br />Form 8700-22 (Rev. 3-05) Previous ZFfim s aro nh.mm. <br />GENERATOR'S INITIAL COPY <br />