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Please pdnl or ype.(Form deslgrred for use on e0le(12-PRO t awnlat) Form Appiraved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1'CrorwmWlU Mpnha 2.Page td xEmm .Response Pham d.Mmdfosl Tracking Number <br /> WASTE MANIFEST 1(j : 15384195 JJ K <br /> S;,C3omm's Nam and Mir+ AdN�� feWfs Slly Address(I drharortt than mNAmU addrM:) <br /> ill .NSNUrr� ql/E_ S7�x- ate CA. R6�� <br /> Gepvnds Plane,, 4/- 5-3 0 <br /> V.S EPA to Numbor <br /> 6,Tmrepodar 1 Company NO" <br /> SG CpW— E{�O / 7 ZZ <br /> 7,TramporMr2 Company Name U,g.EPA ID Number <br /> a.Designated Fadsly Nnmi and Site Address NEV�n�y ✓1.— -r..f•Y U.S.EPAID Number <br /> u 'g-' c-t/ a✓^7 (/'s�Y7 7'100 3 <br /> Hyl �Sr �r Mites -5 , o� ✓ rTyf ' y 7 / <br /> Fadh Is Phore: .p .-. `] <br /> ga 9bU.&DOT Descriplbn(IndWing Paper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total V.Unit 13.Waste Codes <br /> HM and Parking Group fifany)) No, Type Quantity WINd. <br /> g N& 307-71 OAST ✓ZVOL4-S L-- s-C'57 1 -A vt pre,_1 i f <br /> - - - <br /> LD <br /> 4. <br /> 1.1.Spodnl HDMtlng lollclimn and Addllbrol Mfomradon <br /> 1)µ,xi cu Lk,1-7 <br /> 0-g 6 - W*3677/ <br /> 15. Q–C)TOR'SIDFFEROR'9 CFATIFICATION:Thereby dedea Nalllrecontarh of Uts consignment are fully and=are"dasaiw above by the prcga napping name,end are desalted,packaged. <br /> marked and IabelodrplacaNed,and are In at)respects in proper cooditon roflarspmd aaording M applicable Inlernallanaland imperial governmental regulators.If export shipment and I am the Primary <br /> Exporter,I certify that the conlems of this consgnmenl conform to the le[ms of the an shed EPAAcknowledgment of Consent. <br /> I cedirylhal the waste minllrYdatlon statement lderYged kr 40 CFR 26227(a)(d lam a logo overfly gem,oloor a small quanl)ty genomtor)N true. <br /> Ga+nrala'910Neials Pdnle ypad Naamme�/� -Slgwlu Monti Day Yon <br /> ('C'Ti/'— <br /> 16.Inlenuunnd Sl vmonb L1 imPal to U.S. ❑Expcdlram U.S. Port of enlryleAt: <br /> F - Dale loavrig U.s' <br /> Tanspodcr,gmbuo(for exportsaNY): <br /> zY 17.TansponerAcknoWedgmentof Receipt of Materials <br /> ETmaxpOter 1 P(mludNy Name SlgnaN Month Day Ynar <br /> t/e�� �'arJkFAN y �� <br /> Transporter 2 PnnleNIO'd Name .',nature Month Da/ Year <br /> } 18.Discrepancy <br /> Ina,Discrepancy lndicalion Spam angry EITygp bogy ❑Pana;Rejection ❑Fun RejeGbn <br /> �aoe f � <br /> Vrs A,lemafe Fadely for Gengalm) US.EPAID Nurrman <br /> Epi 1"� 01 2W <br /> LL Fn[iYWe Phone: <br /> cfdoalo Day Your <br /> W IacSignaMaerAllmnito Factory for Geromlm} <br /> a E'SVI�f�?tIMF- 'i AL Fly a l i'H <br /> H19.Hazardous Waste Report Menagemenl McUod Codes(I.e„codas for hazardous master laatmen, a ,andm "'sysems <br /> 0 1. � 2. <br /> 3, (r <br /> 20.Deslgnalad Facility Owner orOperalor.Cemnratlon of mreiplof hazardous reatedals covered by the manifest oyxpt as noted in Ilam 18a <br /> Pr Iod/F1yo1 sgnhhac A � <br /> EPA Form 8700-22(Rev.3&U' Previous agi'. Aare obsolete. OESIGIVTED FACILIT'/TO DESTINATION STAT£(IF REQUIRED) <br />