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ft e/Time FEB-02-20091MON) 16: 20 P. 003 <br /> ' "A^02 2009 4: 29PM HF�SERJET FRX • p. 3 <br /> 11 <br /> Please prinlor KS*.(Form designed for use on elite(12-pilc r.J Fortn Approved,OMB No.205MO39 <br /> UNIFORM HAZARDOUS 1.GenereAirlDNumber 2.Pagela( 3.EmergencyResponse Phone 6. en at Tracking umber <br /> WASTE MANIFEST CAL.000320M •$ C'� 003567534 J J K <br /> S.Gen sNamearq MaIIM9AddgtWW Generators Snellddress(ddlAennt man malting address) <br /> 4343 E:est Fromort Ex. <br /> SEot itm,CA 05215 <br /> Genoratora Phare. 209-S46-01 I 1 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number . <br /> CaWorrNe E7nk o rtsertal&UCIo CAR000000810 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> AsbME71Yf9fYSIBPd$BMW6 CAD02B2nm <br /> a. Ned FadNa e a S a PCd ass, C� U.S.EPA 10 Number <br /> SVS B.EIV"AVWM CAM7030M <br /> Lee AnD Ieii,CA 9005B <br /> Fachli IsPhone. M3'277-15M <br /> ga. 9b.U.S.DOT Demoripaon(incbding Pmpar SNpplmg Nen e,Hazard CWSS,D Number, 10,Contains11,Tafel 12.Unit 13.Woods Cod" <br /> HM and Packing Group It any)) No Tyre Ouenaly, vnNN. <br /> I. Non RCRA HxmindoUs waste. &IUW(waste oil) G 221 <br /> Oa �ry� [ v Norte <br /> W 2 G <br /> 3 G <br /> a. <br /> 14 Special Hetdarg Instuctionsa;dAddiliwi information - <br /> e.Webs o11 I+p -7 7100 ERC#MIT( <br /> l7l 3521 �S$ <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATWN: I hereby deCare gal ma tamers of lhawnsgrment are fully and accuratelydescibed abwR bymepropershlpphg narte,and arodaasiled,packaged, <br /> marked aM'abaladryflaceraed,and are h aA r"ped6 N proper snGthn b trans0om acccNing to aplrlcaUe inlemedanalaM nadanN goremmenml regNalions,Il axuon shlpnenl and l am me Primary <br /> ExcMar,I randy that the cenunts d this consignment oon(ono to the teens d the attached EPAAcknowledgmerd of Consent <br /> I®refylhaline walk mhdml7a01n NNemant IdenOfmd h W CFR 262.Z71a)(d I am a krge pwntitygeraerN )w,'bl(tl am a smallgtenfcy genesbr)is we. <br /> Gen5jW.*aemr's PrIMadRypeO Name Signature Mont Day year, <br /> c��G_ LLL Olt <br /> 16.InternalBnal Shlpmenk p ❑Exponl w Pon of en le' <br /> Ins on to LLS. M - <br /> = Transporter sigaapme flat exports only): Date loaving S. <br /> w 17.Transporter Adeno itedgnent e(Recelpt of Materials <br /> C Transp��i�lf"d Name Signature Mont Day War <br /> R l//1 <br /> up <br /> ransporter 2 PdnledlTyped Nerpa SlgnaNre Mont Day Yeo <br /> LLJ(Tj�/v U2 ZO 05 <br /> 1a.Discrepancy <br /> 16a.Doompancy lneiadon Space ❑ 0'ealily lJ Type El Rescue Li POW Relll L-1 Full Rejecion <br /> Manifest Reference Number: <br /> 18b.Attpnak Facility(or Generator) U.S.EPAID Number <br /> J <br /> U <br /> I FaulVs Phcne: <br /> QW tap.Signature dAlternate Facility(or Geneslor) Mont Day Year <br /> 2 <br /> 19,Hazardws Vhste Radom Management Method Cod"li.e.,cod"b(hazardous comate Valliant,disposal,am recycling sYslmns) <br /> O1. 2. 3. 4. <br /> 211.Dersigro'led F cARy Ownar or Operal"..Unification of receipt of hazardous moderate covered by the manifest except he mAsd in m 18a <br /> Pnnk ypedN SgnaNm Month Doi, year <br /> (073110 31 a$ <br /> EPA Form 8700-22(Rev.3 5) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />