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Please pant or",{Farm d toed for use on elite(12-pitch)Iyps ) Farm Approved.LIMB No.2050-W39 <br /> UNIFORM HAZARpQUS 11 GBnerathrlDNumber 2 P tai 3.Emergena R nsaFrmno 14.N T g uer <br /> WASTE MANIFEST C A L .0 0 9 3 1 9 5 3 2 1 E 42a-�ao ,�,j ( <br /> 5.Generator's Name and Mai: Generators Site Address(t dfilerew than mailing address) <br /> Iwo TREI Address <br /> BIan; ox ow RIPON IPONoivr ao <br /> CA 9M CA <br /> Generawo Phone: 29 .2112 <br /> 6,Transporter 1 Companv Name U S EPA ID Number <br /> AS"YEWRQW*WTAL SERVICES C A D 0 2 B 2 7 7 0 3 6 <br /> z Tra"priner 7 CfmmpanyName U.S.EPA 10 Number <br /> 8 Deslgnaled Fadlq Name and Site Address U.S.EPA 1D Number <br /> SIS WATER Tit O GES CORP <br /> 5M SOMH LOS A � AVENUECA h <br /> Facili "s Phhara. <br /> r2W77T Q 4 <br /> 9a 9b U S OOT Descrrpdon(ercludmg Props[Sboping Name,Hazard Class,ID Number, 10,Containers 11 Total Q.Unit U Waste Codex <br /> HIA and Packing Group(I1any)) No Type Ouamhy 'MNot <br /> 1 362 <br /> rr <br /> a NON-RCRA IRQ WASTE,SOLID(MY SOLID r DM P <br /> to <br /> � L <br /> w ' <br /> t.7 <br /> 4. <br /> 14.6pepat Wondang Inatructona and Adddienat information <br /> MERG6981 171"PROFILE$991 *AD7lVopj L EPA C0UES Q31 .,P ONE'APPROPR ATE PERSONAL PROLECTM <br /> 15. 4ENEWOR'SlOfFEROR'S CERTWICAMN: I hereby dedare that the o(Arlerds of thts conaMmerd are fully end aeeeralaly described abtwu Myr the proper shipping name,aM aro dan fled,packaged, <br /> markad and Iabakd)ptamrded,and are in al respeds in proper rnrhdition fnr Imnsporl according to applicable¢tlemational and national pare manlal regulations If export shipment and I am the Primary <br /> ExpoAer,I certify that the corhtents of this consignmernl conform to fire terms at the attached EPA Acknowledgment of Consent <br /> I car*that the waste min*zation statement identified in 40 CFR 262.27(x)Itf I am a torch granny generator)or(b)(if I am a small cluaeaty generator)Is uue <br /> GenmalorsiOlfaroes Ptlntadflypad Name Signature Month Day Year <br /> 16.Irftmoliartat5hipmerds f�t I�I <br /> fJ Impart to U S l _I Exparl from,U 5. Port of ftylenC - <br /> Transporter sgnalom tfol exports only) Data leaving U S., <br /> LU 17.Transporter Ar knowfedgmerd of Reg*of Materials <br /> Transporter 1 PrunedfTyped Plaine &gut" �� Month ay Year <br /> CL <br /> En <br /> Trarsportar 2 PnntedlTyped Name Sig alure l ftwth day ear <br /> r- <br /> 18 Dhscrepency <br /> 18a.Discrepancy Indication Space Quantity El type Residue ❑P'arhal Reoclion Full Rgecdon <br /> Manifest Reference Number <br /> 1 ab Altemale Facility(or Generator} U S EPA ID Nr,mber <br /> J_ <br /> LL Faclity's Phone, fdonih Day Year <br /> LO 10c nature o1 ,mate Faafdy(or Generator) <br /> a <br /> 0 19.Hazardous NfasW Report Management Melhod Codes(+.e•,codes for hazardous wase treatrnea disposal,and recycling systems) <br /> 21 2Ell <br /> J 4 <br /> 20 Designaled Fadtily fkwher or Operator Cefdflcalirn of mcepl of ihazzatdcus materials oovarad try the manifest eruapt as riled In item laa <br /> PrintedlTyped Name gnature morin bay Your <br /> EPA Form A700-22(Rev-3.05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />