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.� <br /> Please pont pe:(Form designed for use on elite(1&Kroh)typewdtrit Form er.) � - � '. Approved,OMB No.2050-0039 <br /> UNIF RM HAZARDOUS 1.GenerebrID Nlamer _ 2.Page'1of 3.Emergency Response Piano 4.Manifest Tracking Number ms � -. <br /> SITE MANIFEST . H"._;1Ci.ti2.17? : . (9111))-+.24-!p C+r.; �,l:.f r LE <br /> S.Generators Hama and Wring Address - Genaramrs site AaNess(adMaentthan malting aadress) <br /> T der rs'sere°f^e.::i+fr.. - 'I'eegY.'2 x'1:394 1.t KSu"t <br /> 23A a<::isnland Ct 143A s4. <br /> Saix'rrrtierld. CA 3ti '1 �1tP`n 9.9dt7r} M8t31 rw's,C& 95337 <br /> CemsmWs Phom- <br /> 6. <br /> - <br /> rampoder . . _ -� U.S.EPA'IP" <br /> SELSHIRE <br /> 7.Tranapmter 2 Cwowny Noma - _ .. U.S,EPA ID Number <br /> S,Designated Facility Name and Site Addrese _ ,- U.S.EPAIDNumher <br /> US Ecalogy, Noyada Opp atif3n5 <br /> f?tgtuya} I. 11 tnf)ss 8 at Baa#} Nv;33W11 GGA, <br /> TJV 931(13: (77$)663-22D3 <br /> F s <br /> -gb -frb.U.S.DOT Desmpbon,Cmduckg PmperSMpplg Name,Hamid pass.ID Number, 10.Containers 11.1otal .12.Unit - - .13.WesteCarias <br /> HM and PacldrggrpW(0any)) NO.: TYPE O"k.6.. ;Wl.W1 '��2• <br /> 0 1` Nwi-RCRA H=sr'ous Waste, Sa1id P X52 c <br /> 'W 2 <br /> 3. . <br /> 4: - <br /> *� <br /> 14.Spedel Ha dirg iromudiarie andAddilaW WanrelM <br /> ERC# 171. <br /> R ALL APMOP21ATE BE'S1:� 1 <br /> Abagrbertt, Filters, Ov*As Cerra rdnawdwfth :PERSONAL PROTECTIVE TMAER CCN:6W,6% <br /> Ciasoi}ne CLOTHING. <br /> PROFILE# 07-012-2500-3M <br /> 15. -GENERATOR'SWFEAOR'S CERTFICATION: I hereby declare Mat theme of this carelgnmanl ere"and eauralery 0esrn'bed-above ty 111e oDpersirWrig rwre,and are classified,packaged, <br /> marked are Iabeiedplacarded,and are In all respects in Koper mrdi6on for ea sport acorcing to app"Ne Ntem tonal and national governmental regulations.Import shipment and I am the Primary <br /> Exporter;l certify that the contents of mis consignmard canfam to Ore le ms of 0re agaiired EPAAdmAedgment of Consent. _ <br /> I w*mat me waste rournbaton sblanantidentted m 40 CFR 26227(x)(l I sm a large gummy gator)n(b)(M a small quantity generator)Is true.r <br /> s rIlnt ame _ _ �9p ( . ear <br /> a. vo 1`1 r✓f '{ . <br /> -+ 16.IntanatarW Snipmads . . <br /> _ ❑1 10 U.S. DExpod ban U.S. �ofen 1 <br /> Z <br /> Transport- hue for - only), Dabbs' U.S.: <br /> V.TrasporterA&iawbtlgment of Receipt of Malene6 - . . . <br /> mom M <br /> Transporter 1 PrintaNTyped Name- <br /> za ranepater7RFbdrP/pedNam <br /> ear <br /> 1 16.fMscrepanry <br /> I <br /> 16a.Deaepaay Indication Space ❑ Guantity ❑Type ❑Residue ❑Partial Rejatlbn ❑Ful Rejedon <br /> Manifest Reference Number. <br /> iBb Atiemae Farlry(a GaWabr! . . US EPAIDNum ar .. <br /> LL F aPhaie <br /> W ilio Sgreb,amaternale Paoi9ry(er Generemr) Mom Day Year : <br /> z <br /> 19.NaaardooV&ele Management Memod Codes(i.e..wdm fa lrazardwa waste b intenk dispmel,and recvdag systems).. <br /> 3 4 <br /> 20.Daagnele3Fatgly0w WOpaatar CaVcabmofmcelptulhamrdowmbedaismYeMdbymemanif mceptnrawmgemtSa 1 <br /> prqF eb ffypea Name c k Signature w ! Mong Day Year <br /> t <br /> EPA Form 8700-22(Rey.3-0 5).Freviou� ltiamt are_b$o(�te. DESIGNATEDFACItITYTOGENERATOR- <br /> / <br />