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Flea bo pdntarylle.Torn detipned for uzc an 812e 12p ypewpilac • FORn Approved.OM8 No.2050-0p�9 <br /> UNIFORM HAZARDOUS 1.Gmimaia lD Number 2.Np I of 1 1 EmalgovalrRuponae Phone4.Manifes111aching Number <br /> 411ASTE,AWFEST CAT-000269375 1 866-909-2783 007454621 JJK <br /> S.GrmaramPs Nona and MYyrm gddrvs Gonmames SM Address oaimerem man m4ng address <br /> Back 6 Pull -Smaztic on ( I <br /> : 3927 Clark Drive Atte- Doug Grose <br /> . 3827 C1erA; D=ives 5tas$ckan CA 95205 <br /> Stoclrtax, G.° 95295 r <br /> Gmemmesphorm: Q16. 74n-3'a:.T+ <br /> O.Transpode(1 Company Name U.S.EPA ID Hunter <br /> Vmr2d0itde Becowerg Sgsteess, Inc. CAp00017S422 <br /> 7.-Ipnwd r2 Caropcny Name U.S.EPAHI Number <br /> Sndti'Pt..a3 Mra—.lc IIiili.xation CADVOO805293 <br /> eAA blad <br /> ColNaniiViloAddreas U.S.EPAID Number <br /> 1.925 S_ Factor Atte_ <br /> Ran, AS 85365 <br /> radmyaPMne: 928-783-3x76 ASS00050v510 <br /> I <br /> 9a. Be,US,OOTDesaip4on[aehal4�g Paper 56pp!m Name,Heaard Class,ID Nmnba, 10.CordalnOn 11.TaUl 17,Unil <br /> HM %ad?a6k,9GmuP(dony)) No. Type Quantity WWoI, 13.Wale Godes <br /> 1. Jfvast xdr .L^ tls c o) i i p52 <br /> p P.fa�o;*.aeRt, Delari�)it <br /> p <br /> a + <br /> `w <br /> 7. <br /> 4. 1 <br /> f , <br /> 17. a HandYrg lnabucaons arNAtldivnal ln.roc�mn <br /> 1 515727-BLl 'Y <br /> Bill to •orlsduide; tear Appropante Protective Cln+ti: <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATION: I hsmhy dadme Out the Wnbnt.atedo consignment ars fAy and a¢uatey ab are by the prape,:Ja pnq name,and em d=oped,Dacbged, <br /> maAad and labeladpleoerded,and are in ae mspoctsin,propermltdrdOA for banepmt eowrding to applk&a neanabardand mmenml 189111abou It noun shipment and l am the Pdmmy <br /> Eqp r.I renlfy deal bre mNants of this consignment Conform m the terms ofthe aRBMod EPAAcbnoWedgm-1d Gmwe <br /> I wrb'ry,that the waste mWmI?Adn stammentidarmiiad Ing CFR 20227(a)(a lmnelerye WanmY gore (b)(RI asmall generator)Is We. <br /> GaneratofslORamis PnM yped Neme Month Oey Year <br /> I16.Inlemeppinl9hpmn <br /> ❑EaWdfmmU9. lve <br /> Z IMMpodm signahme fon erpaanyy. Date havinVS.: <br /> 17.TnroppftAdmawledgmenl of RmptdMaleriab <br /> TmnyP WI yped Nome $ig Monty Day <br /> Year <br /> n l/ <br /> Trenapo = P iwa fylueQHears—r• 9qn Month Day Year <br /> Tv ZP <br /> r16.Dieaepuncy <br /> IftWnapamybwmdan9pue <br /> ❑ qumility ❑Type ❑Residue ❑PeNal Raacem ❑Full Rgedmn <br /> Marthm RmaWca umber. <br /> 15b.Nlemete Fadfy(orGazramtm) U.S EPAIONumber <br /> J_ <br /> V <br /> tai Fediys Phone: „ <br /> w IIIc.SiynuMm of AlmmeWF y(ar GenemloiJ Monro Oay Year <br /> 4 <br /> z <br /> m11.14mm:ausWaite Report Management"ad Codes On,coda for haaaldauewaam bammumt,dlsposal,and notoing eys,,,) <br /> p 1. 2. S. 4. <br /> 20.DC�'alod Fndsy _ ar weramC CarticTl;an o_(rocapt A ho±7)doUs IImNAdS mwred try ma mmnilesl pt ndms' m 18 <br /> Pont i NdI�I—��� 5' urs Ma year <br /> As CpZve;EPA Form 070422(Rev.M5) faraIlous editjorrs els o0dalete. ,pESIGNAT' Il ITYTO OES7INATION STATE(IF REQUIRED) <br />