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Please (Int or type:IF6ml desig6d.for use on elite(121pilrh) 'ler) 1 r Form Approved.OMB No.20504039 <br /> NIFORM HAZARDOUS 1.Genemtor ID Number - 2.Page1 d 3.Emergent Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST .si..C'C4Y:. ,,, - c ($ul:f1..4 ,iceP Q 0 5 /.7 99.4 F L E <br /> 5.Genaretors Nam and MabingAddPaes Generators Site Address Iddifferemthan mailing- ress) - <br /> v: r'Energy, GFT.�v, T4wlrer 'Anrt ff-$,�!: <br /> 0 <br /> Gold-inland Cf. 1434 q+.. Y'da.on'le Ave <br /> Sacrarrlerto Cd 173'Azl �. €r'ic Alexa: C-A 95537 <br /> Generators Phone: {31()3.rua1�-Rt1D0 - <br /> Trensporcar i CompanyName _ - U.S.EPAIDNumber <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Fadlity Name and Site Address - - -' `U.S.EPAID Number - <br /> 200 N. Aiaerseda.St: r1TGStl 1.'_r< . <br /> Fadfdys Phone:. S10'.�w-1100 <br /> Con titan. CA 8022' <br /> gy, Sb.U.S.DDT Description(nciudkng Proper Shipping Name,Hama Claw,0 MuMx, 10.CdnWner4 11.Tdai 12 Unit - . <br /> HM and Paddng G-P(denY)) _ - Na Type Quantity 'WUVp1. 13 WasIe OQQec' <br /> 1. UN 1203.Gasaine Mixture:3. PG It. ' <br /> o X <br /> �- LlPA 1 <br /> 2 FOR RECYCLINGAREATMENTS AT THE MIR <br /> DeMENNO[KERDOON FACILITY IN COMPTON,3. CALIFORNIA.THI )PERMITS TO RECEIVE YOUR WASTE STREAM AS H <br /> 4. QUOIEBAREPANUMBERISC <br /> 14.Spada]Handling hatruclicns and Additional Information Y1EAR ALL APF'ROPRi?lTE '. 8 E tS I. 4 � rt <br /> ERGfT 12x3 <br /> Gasoline &Water PERSONAL PROTECTIVE. TO' 4ER CCN; e'22e(; <br /> C X ,j7 C-OTHiNG. <br /> 15. GENERATOR'WOFFEROR•SCERTIFICATION: I hereby dedare Ihat the contents of d:s consignment arefully and accurately described above by line proper slipping name,and am assailed,packaged, <br /> marked and labeleNplararded,and ata in all respects in proper condbon for transport according to aps,able imamabonal and national guvemmental regulations.Maxport 9 m nt and I am line Primary <br /> Exporter,I artily that tore connants of his consomrd conform toMie tonna d tone atradmd EPAA6jwMedgmem of crosenL - <br /> I ceNty,M tine male nnnimbation stalerneal Identlgad In 40 CFR 262.27(a)(d I am a large quantity gen rator)of(b)gfl'm a small quantity garamtor)Is We.C,a ..- <br /> rnemw . ma 649MMIS� p,e ear ' <br /> E.a 16.�mematonal sNpriazns - <br /> �z <br /> El hp4 to U.& ,❑E>pon from U.S. - Ponder <br /> T er ' nature for }. Date leavrg U.S.: - <br /> d' 17.T ArknoMedg'nerdd Receptd Matoriais <br /> Transporter 1 PnnteNfyped.Name nature - ay <br /> Yeer <br /> 01,r � 1 \ x'u ;)�U g <br /> Transporter 2 Pdnted4YPed Name - re ear <br /> t18.Discrepancy <br /> laa.Discrepancy lndxatlon Space ❑ []Type.. ❑Residue ❑Panne Rq.-b n ❑V4 Rejection <br /> IManifest Reference Number:.. <br /> 1St.Attenate Fa"(v(3anandor) U.S.EPA ID Number <br /> Q . <br /> �- F Phura:-' - <br /> --- � 18c.SIgneWredAMetnah Faddy(or Generator) - Month Day Year <br /> 2 <br /> 1g.Hacardoiu Waste RepodMauWamenl McMwd Codes(I.e.,codes for harardous waste beament disposal,and recycling systems) - <br /> C 1 2. 3. - 4. <br /> /0,), _ <br /> 20.DesigratM Facility O•vnerorOperator.Certification drecelptdheyardour materials covered by the manifest excepl@snotedhitem l8a <br /> PnmeNryped Name..-. � Signature I Month Day Year <br /> 1f <br /> EPA Foim 8700-22(Rev.3-05) Previous editions areIete, i s, DESIGNATED FACILITY TO GENERATOR <br />