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• • DISC. 00970. .2233 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Forth Approved.OMB Na,2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 101 3.Emergency Response Puma <.Nanlleat Trecking rn ANp _ <br /> umber <br /> WASTEMANIFEST eA. �.000( �(� � � 8� 483- 3a Is 000237842 JJK <br /> 5 Generetoya Name and Mailing Address Gemretoh Sea Address(0dilfinent ten mailing address) <br /> ILi �I SIs�T-fCA ae��o K - C.ha v- l e s TU rr ct-� <br /> Ifs o LA.0 .Ci3h+ M'%kr- I�,JtoctzAt>r-,,,CA Uessei - LI-15( Rif <br /> Generato/s Phone. a-C)� (Be . <br /> 6.Tmmpohmar I Company Name U.S.FPA ID Number <br /> Cl640 14viii UIGJA �woo3932��S'C) <br /> 7.Transporter Compaq Name U.S.EPA IO Number - <br /> 6.Designated Facility Name and Site Address U.S.EPA ID Number <br /> toll 3si��� �S133 <br /> "� <br /> L. sPhone: k4oY - I - 0111,1CAW59ggq 31(, . <br /> 9a. -9b.U.S.DOT Description(inmdin9 Roper Shipping Deme,Hazard Class,ID Number, 10.Conteners 71.Total 72.Unit <br /> HM and Padtlng Group(dany)) No. T n O 13.Waste Codes <br /> Ype UR" W1Ncl. <br /> o vA)3► 8 �law.w�oble 5olt tnnrgaa;c , mfg31 114 <br /> W <br /> 2 2. <br /> W <br /> C7 <br /> 4. i <br /> 14.Special Handling InsWcti m arid AddNmal Inforatm O C <br /> q61 CN 3%.3581 rob �T$2�8 GJ <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATION:I herebydadzre that the mnbms of did mmgmenl aie hdy and acourstay,described above by the proper shipping name,am are dasvfied,packaged, <br /> marked and labeled/Placarded,and min all respects in proper condition for transport according to applicable irdematonaland national governmental regulators.N export shipment and I am the Primary <br /> Exporter,I car"Nal the constants of this consignment co form to file lame of rip allachad EPAAcknowfedgmem of Consent <br /> I rorty that fis worts milimvation statement identified in 40 CFR 262.27(s)(8 i an,a large quantity ge ndalm)or(D)(dl am a srrysti turnery generator)b true. <br /> GemraWS/Offews Pmled/Typed Name Sigmturs /, Monro Day Year <br /> 16.Intsmamnal mpmmb <br /> _ ❑Impon to US. LJ Export fan U.S. Pn teneylett <br /> Transporter sigmbrre(far exports only): Date leaving U S: <br /> W 17.TramponerAtlmo,Nedgmem ofRaceipl of Malmiss <br /> Transporter 1 PnntedRyped Norm <br /> Signature, Moron Day Year <br /> .. <br /> 0H Raowr�v ti e. Sa , oy oY og <br /> Z Transporter 2 Pnnte*Typed Name <br /> < re Monro Day Year <br /> 18.Discrepancy <br /> l9a.Discrepancy Indication Spam <br /> ❑ Duantty ❑Type ❑Residue ❑Portal Rejecibn ❑Full Rejection <br /> Manifest Reference Number: ' <br /> 180.AlternateFadldy for General - U.S.EPA ID Number <br /> V <br /> LL Faci Ws Phare: <br /> Maj 18cSigmWmofAelarmte Famiy(orummetor) Monro Day Year <br /> Z <br /> h 19.Hazardms Waste Report Management Method Codes fie,miles for hazardous waste tre rtment _ <br /> dispmal,and recycling systmns) <br /> LAW 1. '' I 2. 3. 4 <br /> 1 20.Designated Facility Owner or Operon Cordfimtm of receipt of hazardous materials Covered by the man Msl t as noted in Item 18a <br /> YPed ignamre /1 ` Month �ay Year <br /> EPA Fan 8700-22(Rev.3-05) Previ used'Nonsamobsolete. DESIGNATED FACII`ITYTO DESTINA ON STATE(IF REIOLIIRED) <br /> 10540.2168 <br />