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m_-se print or type,.(rorm ftigned for use oft eri(e(12 pi,. 1 , ei4 r) `onApproved.0M8No.2050-0039 <br /> UNIFOR I.GeneratDrID Number 2.Pagel of 1 3.Emergency Response 14.F <br /> _M HAZARDOUS 0 TraCking Number J <br /> WASTE MANIFEST I C a k fl;G Q 32 T G S 1111�4778-1 02. '�� J <br /> 77JJK <br /> 5.Generators Name and Melling Address Generatoes Site Address If different than mulling address) <br /> T-CAASERWRTONX , I <br /> 20 LALM C.T <br /> Mg.,;EArro Col. WE--4 <br /> Cknerato a: <br /> 6.Transporter I Company Nam U.S.EPA ID Number <br /> ENVIWNI RE-MEW.;EIMCEO,INC, C A P 110 Vj 1 8 S 2 01 <br /> 7.Transporter 2 Company Name U.S.EPAID Number <br /> 8.Desit;naled Facility Nam and Ste Address U.S.EPA 10 Number <br /> "GENIEW40 KERWIN <br /> I=tNORATH'LA W-DA5TKEET <br /> FacDO <br /> ilia Phone:l' (3 1 0)W-'I CATI2800-13362 <br /> ge, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers it.Total Ii.Unit <br /> and Padding Group(dant)) 13.Waste Codiss <br /> No. I Type I Puslaft <br /> HIM WILIvol. <br /> WA512 FLANWEILE UQUI 0, N.Ob,3,UNiSM PGL'pxsoi 1INE,DeNizew <br /> of orm Dole 215 <br /> G <br /> THIS WASTE STREAM HAS BEEN QUALIFIED <br /> FOR RECYCLING/TREATMENT AT THE ';-", Prr a i-ua <br /> 3. bvMENN01KI7RUUUN WILI I Y IN COMPIUM, K� <br /> CALIFORNIA.THIS FACILITY HAS THE NECESSARY <br /> PERMITS TOR YOI IR WASTE Slum AZ DEC 17 813 <br /> 4. QUALIFIED. OUR EPA NUMBER IS CAT080013359 <br /> EN 1R( <br /> H <br /> 14.Special Handling Instructors and Additional Information <br /> iii)Tmm"ewTiK-GASO'JUETA94MWATER 1213-901111 IW,%-&M-ER5WC*%495-lli" <br /> MLL TO ENViROSEfV"WEAKPROPERPPE <br /> TK. G—ENEiRTOR'SIDFFEROR-SCERnFICATIDN: I hereby dedam that the contents of tots consignment are"sM acoumlelydesabed above by Ne proper shipping name,and are ilasWW,Padwged, <br /> marked and labeledliplacarded,and are in all respects In proper condition for transport according to applicaNe international mid national gravenumouttal regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I oer*that the waste minunization statement identified in 40 CM 26227(a)(d I am a large quantly generator)or(b)(dl ant a mail clumbity gmerator)is he. <br /> Generator's/Offerors Prindecirryped Nam S"ar - 4r1 MonthQ Day' Year <br /> ocz <br /> Antoma alShipments 0 Export from Uj Pal ofexit <br /> no U.S.:U. <br /> Transporter silurtatum(for exports only): Data rig U. <br /> CC 17.TransporterAclonowledgmert of Retcelpt of Materials <br /> W — I <br /> Transporter 1 PrIntedlTyped Name Slorsh Martin Day Year <br /> 0 <br /> X Transporlou2 PdnWy*Name Sonature Month Day Year <br /> 1S.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity Realdue- ❑Peru Refection ❑Full Rejection <br /> Manifest References Number. <br /> 18b.Alternate Facility(or Gertmalor) U.S.EPA ID Number <br /> LL Facility's Phone' <br /> W l8c.Signature of Alternate Facilfty(or Generator) Month Day Year <br /> Ul.Hazardous Wasle Report Management Method Codes(i.e.,codes for h=rdoos waste treatment disposal,and recycling systems) <br /> 1 2. 3. 4. <br /> 20.Designotgol Facility Owner ot0peralor.Certification of receipt of hazanJous medoxials,covered by the manifest except as noted In thern 18a <br /> Pnn7 Name 9 Signature Month Day year <br /> EPA 1romm87M22(Rev.3-05) PreWousecIllWardnhsolets. DESIGNATED FACILITY TO GENERATOR <br />