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,ix Date/Time FEB-02-2009 (MON) 16: 20 P- 002 <br /> Feb 02 2009 4: 29PM HORSERJET FRX • P. 2 <br /> Please print a type.(Form designed for we on efrte(12-pitch pemntec) Form Approved.OMB No_2050-0039 <br /> UNIFORM RDOUS 1-GalertxlO NaMec 2.Page id 3 .panty Response Plane 1.Naneaa Tracking Number <br /> wOT ANIFEST Go�j�,2-((,-�/fl 003567535 JJK <br /> 5.(3arer5lors Name and Mallirlg Addte95 UeneraWs Site Address(8 dillerent Man mailing address; <br /> PI¢Actdva Nweiem Conbw w <br /> 4343 East Fremor#St. <br /> Sbckw.CA 45215 <br /> GenemWs Prone' <br /> 6.Transposer t Company Name US.EPA IO Number <br /> C ikrr sErNkorxraerdel8lift CAR000009910 <br /> 7.Transparisr2 Company Name <br /> U.S.EPA III Number <br /> A6b111yEmTww11 rW B8MOR9 CAD02&277038 <br /> 8.OesgnAW Featly Name and Site Address U.S.EPA 10 Number <br /> 6161IIBfib Weil TbrdimbsimCdT1- <br /> 5375 S.BWft Avenue CAD097030M <br /> losA-Vol".CA 90058 <br /> Faak 5 Pbone. _ <br /> 9a. 9b.U 3 DOT DesMtofindudiag Pmprer SNpping Name Ha rd Class,lO Number, 10 Cm.rein¢rs it.Total 12 Unit <br /> HM and PaMni;C w(Kam,)) No. Type Duantiry W1Abl. 1l.Waste Cures <br /> C s o ,�•� ao z /�F' <br /> // o G q I <br /> e 13 <br /> 2 tSYt 12C�/k W �L, 001 x/31 G 13Y <br /> C wo Soc_ur1f I&Aso <br /> 3. <br /> Cb�1 z4il v S� G /3 <br /> 30 G- <br /> / Pnrrfr�-a 1 <br /> is Spec<i Haripirg Ire Manda 1 tan <br /> waftdt p 5 ee?Ipll arL, rvtkA-*AP7-7-2099 ER0017 -7 <br /> a L�(�tt saL(GrI�J�/�r 17.749 ( 4 <br /> a-zvio ui c (if' 121toGD <br /> 15. GENERATOR•SrOFFEROR-SCERTIFICATI .'1hereby declare Mat the mrsems of'.nls consigners are unsw a¢u ilelydesenbed abcm by Die proper ping na",.nd are dassded,packs be, <br /> mahed andla'xbdyCxaNed and are all2speasrpapa mnd'Aim la laruportazxdng toapplicabb inlanagor2l and ragmdigmemmenlal regu�tiwu.tfsVw sNaneraandI amthe Nmary <br /> Eaparser.I CeNry Malta mraems of his mnsignmeM mniom to Ne leans of he anecned EPA AckmWedgmere or Casenl, <br /> codify eat Ih wade mMimlaaCon slakmarq Idaneeed"n ed CFR 26227[a)(d lama'a-ge duartiry generator)a(b)(f I am a small quaaey generator)a here. <br /> Ge 2 h PMIW yid Name Signa!u Monm Day Year <br /> oC Y1 ile O 2�`25 <br /> _u 16.m emalional SNipmenta <br /> Z ❑laws 1.US. ❑EU. . Portolenvyieat <br /> T2nspor".et SiIneture(fa eapods dnty): Date leaving U.S.: <br /> W 17.T2rsporlerAcWroWedgmen1 ofRecWdlilammes <br /> OTransom i.P2mNd([ypad Name Signa MoMb Ory Y�e/ar <br /> Is. <br /> +`YY T1a14a/ :Y <br /> ranspoMrT dal yp a Sgnatore Mpn Oat Yea <br /> O�p2 08 <br /> 18,0screpanta <br /> Ila.Oisaepancy Indication Spacei��I R e <br /> ❑Ouenmy ❑Type ❑Residue ❑Pedal Rejection Lit Full exon <br /> teb.Aftemate iailay(a Cxnaralor) Manilesl Reference Number. <br /> V.S.EPA ID Number <br /> U <br /> aQ+- Facdiys Phoma' _ <br /> w i&.Signature dAllemele FadBy(a Gene2eor) Month Day Year <br /> Q <br /> 2 <br /> W19.Mererdaus Weale Repod Management WOW Codee(I.a,rod"for heaardous waste rreamsn(disposal,and recyding systems) <br /> 1 2d.Designated F laygvner a rabr Cerlis of recefpl d m s m Bred by he man a e[ep!as sited m Item 18a <br /> e yPed Name Sgnalure Mom Day Veer <br /> EPA Farm 8700.22(Rev.3-05) revaus dl name e . DESIGNATED FACI ITYTo DES I N STATE(IF REQUIRED) <br />