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Please print or type.(Form designed for use on elite(12-pitch)lypewrker.) Foran ved. <br /> UNIFORM HAZARDOUS 1 Generate 10 Nurrrbrr Z Pae 1 of ?.Fsn APPr° SMB fVo,2050-0039 <br /> Page e9�7'Response Ptxxra 4.AeanlfestTracising Number <br /> PlA5TE MANIFEST 614 R�ass�r s3 6-371-5747 5 3 S �J <br /> 5.Genamwei Name and mafi,g Address fimenerators Slte Address(i(+5fierenl utart maJutg address) <br /> rC3 Dt r e.l r F,�5p SGf t7t D; ' I"I�; t c-SD L ff �fti ff .SG Nara <br /> I3aS E, d'wc 5 <br /> De, CA.�ls'2� 3 .5. <br /> Generators Phone: <br /> B,Traasl+arter 1 Company ane <br /> RAtvTQS EWRONME3TAL SERV9CES 94C, U.S.EPA 10 Number <br /> 7.Tra�crtef 2 Company Name <br /> U.S.EPA 10 Number <br /> ti Designated FaaTty Name and Ska'-sVEOL LA ES TECHNICAL SOLIMONS U.S.EPA ID Number <br /> M&'ILF <br /> F-aatOftn s 2 a 6A'fp0colyoTq <br /> gaUS.lal7FDesafptio,tf4�PorgNene,HaxardCla59,IDttutthec 1R.Confainars 111.Twat 1Z and <br /> HM Pig�q(d any)) Na Type Quan at wtnlor, 13.waste Godes <br /> 1 tjCtJ 'EC094 ,ZqeboGr_5 <br /> Q 'b6GE.S,41r1`II �✓sa' 30 <br /> L <br /> LU <br /> 4. <br /> 14.SpecW Herrrvrg UMMEMS and Adddlonel tnfarrnation / <br /> 931)PROFH.E# E G*]-7-t �P LFr yz •3� ss�7 �4 L �' <br /> E.R CQNtRACTnft: RA1ti M EIWIRONMEN[AL SERMCES <br /> HAKDLMS SHO=6E TRAP ED AND USE APPROVED PPE. <br /> 15, GEIyERATOR Slbf FEROlY3 CER7IFiG471r]N:r hereby dedam that the mrtrads of:tris cvnslgrtrrtenl ere fa&i and acwratrly desk above by proper shpa�pj er>i are class fled,pad aged, <br /> marled end ia6stedlplaoa>det}and are in al respells h prtgrer cud9w for transport accord ng N appbcable Wematiartal and rn5orW gore=zrrW oegutataxra If <br /> Fsprrter I=ffy that the content of this wrk4gnmM cordons to lite lams of the athrisd EPA A grt�of Cmsent export and P em the Primary <br /> I certify hk the waste m rthrcatfon stetemeol WerMed rn 40 CFR ZUX(a)(It am a Amp quantity generator)or(b) surae wwu+ 9-*1$tom. <br /> T 75rzv'cj'4 T5 — Manu Day Ymr <br /> lei 6 <br /> 16.UftelFatdarm!5htpntdtts <br /> ❑import to U.S. ❑Ewt front A,-' Pont of tmiryfent <br /> Dale leaving U.S.: <br /> u 17.Tran3porterA*0*WperA of R_*of M4mWs <br /> Transporter 1 PnaledlTyped Name SgnaWse <br /> L ^� lfatfh t}ay Yeu <br /> r) L <br /> ranspvttrr 2 PnnfedRyped thane <br /> Sign <br /> Month Day Year <br /> 19,Okaeparrcy <br /> 18a t�Oepm y lndicatxm Spam ❑ ❑Type ('1 <br /> ❑Residut• t„_1 Partial fa �d•irE 11e}ectbrt <br /> 1t1tr Alternate Faci"(or Generator) darrifest Referenca Number. <br /> i <br /> U.S.EPA 10 Number <br /> 0 <br /> FacrTdys Ph_.: <br /> 1Ba Sigrraltoa of AGentele FaaTdy(or c' ) hlori@t Day Yrsr <br /> 1g.Hazadorrs Waste ReQaf A{enegesnant Malhad Codes(f.a.,codes fflr bzrdota waste hr t neat del,and recydetg systems} <br /> 3. a. <br /> 20 Designed F&*v Oww or Operator;Ceitk2 Fon of recalpl m trazarmu-natrrials covered ay ere naertf[est except as riled in kern 18a <br /> ted/typed ntarn° 5ignanee <br /> Month Day Yea* <br /> tFam 8700-22(Rev,3.05) Pmvinus edl m are obsolete. DESIGEUME)F:ACI TY TO DES)IRATION STATE(Lfi REC}1 IRr-D) <br />