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^ y <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) l Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS I.Generator lD Number 2.Pagelof 3.Emergency Response Phone 4.hlanhesdt TTXracggkinggglIumb��'e'��r�rraayy'1 <br /> WASTE MANIFEST Vt�L4i LffJ2J10b2 .i .lit,') S,'f-2GE7� oolvv„4 U'c�iy D,15.! DAT <br /> 5.Generaloes Name and Mating Addreas t Generators Site Addless(it diiamnt than mailing address) <br /> VOSIEDUP 66 M. - B57E9UIP Pft; r(1- <br /> Liglilt ENSI i.ffl%&.gU811 r, 1 800 EAST LLICKE fi1)411 <br /> r GenembesPhone 0ME?ORD CH S523f 12041333-441 LOCkEFORD w yml t2O41333-Gti1? <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> J <br /> 'f l.,^ 1)aeru Lriviro mental. Plariaqeal oCalifornia. LP I CAR00021061-,' <br /> �D 7.Tmnsporter2Company Name U.S.EPA ID Number <br /> j 8.Designated Facility Name and She Address U.S.EPAIDNumber - '- <br /> ':15i I:kklslR'$3futlii?df�i'�;Ilt'r'_ i'i',t'.f4li iEii; Of ir'Jll.:t. LLL. <br /> tl; 4s <br /> FadtitysPhone: r 'k:i eo a, '+4of t7? 5-tsti0 NVQYS11t <br /> ga. 91b.U.S.DOT Desorption(Including Proper Shippng Name,Hazard Class,ID Number, to.Comffiners <br /> HM and Packag Gmup 9f any)) 11.Trial 12.Unit 13.Waste Codes <br /> Q No. Type Quantity WLNol. <br /> !.YNi 0CC(i NGlili;DlUS G'tiSTk. ti9L)C' (PN.Tt1 FILiEAuib SCROPPI(th5i 3S7 <br /> 0 g-+ )lt'i 39;150 E - <br /> w <br /> z Z. <br /> w <br /> 3. �—I— <br /> EB 02016 <br /> 4. , <br /> ENV RON NTL <br /> Hca nu aa�*,�FN <br /> 14.Special Handling Instructions end Additional Information <br /> (1)_646031-I16__MOT WITO FILTERS—" PU.OPEE vP1 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment am fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and IabeleNplacarded,and are in all respecm in proper condition for transport according to applicable Internal and national governmental regulations.If export shipment and I em the Primary <br /> Exporter,I cediy that the contents of this consignmentconfarm to the terms of the attached EPAAcknowledgmenl of Consent. <br /> 'I cerliy that the vasa mimmizatfon statement Identified in 40 CFR 262.27(x)(if I am a large quantity gens mbr)or(b)(if[ap�a small quanttygenemtor)is We. <br /> GeneraafslOffemrs PdraNryped Name Skpalurg in Month Day Year <br /> J 16.International Shipments <br /> F <br /> 1:1 Import b U.S. ❑Export from U.S' Pod ofentrylaut <br /> z Transporter signature(for expodsaNy):. Dale leaving U.S.: <br /> W 17.TmmpoderAcknowledgment6f Remiptof Material <br /> 33 Transporter 1 PrInmirryped Name 'Slgnalure Month Day Year <br /> Q Transporter2 PdntetlRyped Name Signature Month Day Year <br /> I <br /> 18,Discrepancy <br /> lea.Discrepancy haicarol Space ElDuantlly ❑Type Residue ❑PaNal Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> IBb.Altemam Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> C3 Fa1.1ky8 P11011C: <br /> y�j 1So.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> 2 <br /> N19.Hazardous Waste Report Management Method!Codes(i.e.,codes for hazardous urine tmatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> 20.Designated Facility Owmerm Owed or.Certification of receiptof hazardous matetlals covered by the manifest except as Med In hem tike <br /> Pnntedrryped Name 1t µp'� 1. Signalure ManN Year <br /> -I 4 ' -( y e lit , <br /> EPA Form 8700-22(Rev.3.05) Previous editionsam,obsdete. �'f�� DESIGNATED FACILITYTO GENERATOR <br />