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Form proved.OMB No.2050-0039 <br /> pdnl or type. Form desl tied for use on elite 12-pllch) Wdler. <br /> I.Genereta ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manl eslTracking umber <br /> 'IjNIfORM HAZARDOUS ',. '"71',`WASTE MANIFEST C1AP, i 32.1) y/�P 1, 01�U-•:ijt '�i//G•/ � ))f,J� <br /> JjJK <br /> JJK <br /> 5.Ganerelor's Name end k�all'mg Address Oemerelofe StieAddress QfdiHernt tion magug address) <br /> 11.0. 130X 9.060, T: it (:A c?'S2/r 1. :i0q BE(I'DJAN ROAD, Til CA 9-19. :0 <br /> Generator's Phone: 20 )••;f;):3•-;jl)U2. . - U.S.EPAID Numher <br /> B.Trnspaler I Company Name <br /> CAD f}/s1� 00;1 ;56 <br /> P'iAP'ill;j P'',PiT)'1.(.1a11Pi1P%PP'tAP, Sl!:P.11,1.('•)>> U.S.EPAID Numba <br /> 7.Transputer 2 Company Name <br /> U.S.EPAID Number <br /> 8.Deslgnaled FSCWNemeand SMAddress <br /> U13t<l P:I:asrP 0.1i :QAC. <br /> G£;.i0 ahL'C`I'Jr i Pdi3t3Al2K, 0111 9fi0 tS�i7 hJ.t3 <br /> Fadi sPhare: (:114) !'.+`j'"11/.10 <br /> U.S. esalpti Wlydiag ProlbrSN"Name,Hard Class,ID Number, 10.Cantalnera J,Total 1'2, 13.Waste Codes <br /> 9a: 9b. DOTD <br /> No. Type Duantlty WINd. <br /> NM and Pal GMP(d 811Y)) <br /> 1. 11 N—R(N WKY.CE 001 .P. �• 1,00 "'1 - — <br /> z 2. <br /> W <br /> P <br /> 14.Spedal Handling Insuucdons endAdGBaglnfamotion .SZ 1,Jif 17 �.�. 1/71,'��t:iJi <br /> 9b.t) tll <br /> )TANINA",RS TO B , 'rS;Aa:Plrt) Alb) USS 1?PI?. ' <br /> l Ord or.cial <br /> 15. GENERATOFrSfOFFmerkadamdebela4/gacaOrded and are neo respedsrn prdopa rta)dltlon fac 4enslporl eccadlnAWeppltkab:e lnlernatlonelaand M natlona ebmmntelragu�8ons.IIffexport shlPTent and l em the Pdmes�l <br /> Exporter,I call that the contents of Ute oonekjnmanl conlorm to the terms of the a8eched EPAAcIronAdOmn(of Consent <br /> I cartf that the waste mintrni slelemnl ldenl n40 CFR 211 Cd l am a large quangtygenereta)a(b)ml em a..11 amml generala)Is We. th Day nr <br /> SI9naNre , <br /> Gemerelors(OBeror'sPdntecilNoma �- /��' J°1 l)q <br /> .Interna at ipments �Impallo 0.S. ❑Expel from U.S. Patofanbyla>iil: <br /> Date leal US: <br /> Transpoder slgmrure(fa expolsonly): <br /> 17,TranspaterAoMMedgment of KWIM01 Maledale Month Day Year <br /> Transporter l Print Name Slghelure �. <br /> ,)r•, .,t, •. .nl�ilx`:.1)! SlgnaMe Monty Day:. Yale <br /> Transputer P leURyped ame <br /> 18.Dleaepa w ❑ <br /> ' Ill Dlsuepancy lndi Space 0untitFNI ReJewny Type QRes!due ❑PedMl Refection <br /> .r Mani Reference Number. <br /> U.S.EPAID Number <br /> 18b,Altemale Fol(or Generela) <br /> I Facgitys Phne: - Monti Day - oar <br /> 0 181 Signature oINtemete I(a garners - <br /> 2 10.Hazudw$Weste Repodhlaragoment Melhodcodes(i.a,codas futazadouswasle bealmenl,dkposal,aM recycling systems) 4 <br /> 2. . <br /> { /IJ / <br /> 20.Des�reted Fadgty Oamar a0perela:CeNflcatlon of recelpl of hazardous maleda49 covered by the manileslexceptas,, ed In Ilam iea _ ,• pay ear, <br /> P <br /> it We Sgnature t� �l/ <br /> 7RANSPORTER'S COP11 <br /> EPAForm870o-22(Rev.3.05) Prevloos editions are obsolete. / <br />