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"Date/Time FEB-02-2009 (MON) 16: 20 P. 004 <br /> •eb 02 2009 4: 29PM LRSERJET FR?S <br /> p. 4 <br /> i <br /> nPainfarry "type rm desgned for use on elite(12y%c wr%er.) Fo .OMB No.2050-0039 <br /> AZARDOUS 1''3enerator"Dumb er 2.Pagel o! 3.Emeyenq Response Phone 6-Maneeat Tra, Runbw MANIFESTCA 91103WIlry { L JJK <br /> fs Nameand Mairmggddress Genembys Site encs 11 dmerenl Ran maditg address) <br /> ,4 ye Nortiern Cmrsiar3 East Fraff ort St <br /> dbirt.CA 95215Phone:er 1 Company Name U.S.EPA ID Nw.>er <br /> CalftDRIIB EIrAmy- rsarrtd A I.1dle <br /> T.Trwa,:mer 2 Canaany Name <br /> U,S_EPA b Number <br /> 10 <br /> 8.Desig121ed Earn,,Name m0 Ste Address U.S.EPA ID Number <br /> SiertmeFra WetvTedrnIagm Cap <br /> 5375 S.Bayles <br /> LOS NVelin00 CADOD7033003 <br /> Fad%tys Phone: <br /> ga 90.U.S_DOT Description(ndudrg PmOt'ShiPpmg Name.4MIJ 0ass,'D Number <br /> 10.Contirwn 11.Total 12.Un% <br /> i HM andPac4rg Grotp(dairy)) No. Type QuanYry WtNOL 13.Male Codes <br /> o Non RCRAHamdous waste, pgttd(caste De)z G 221 do21 1 l/o Wris <br /> Z <br /> NDn RCRAH®rdous waste,plRldd(waste W <br /> P <br /> 00/ DMI I None <br /> T <br /> Nal RCRA HU rdars made.wtad(waste tadrltein sNubw) f ( t t/ G ' <br /> DoZ D <br /> ° <br /> ( 1 -711 <br /> � <br /> coo 1 D 6-- <br /> ni 114..SPBdaIHanQrg lnslmscliom arM o�in a n 1n�r z--� V <br /> Waste <br /> b.w seta r k � EROA171 'j <br /> t c.waste founial Y s avATION: I hereby declare <br /> The ms tar.opt.kilts a �- O(1.t.1al� W <br /> :15. G�NERATOR'BrDFFEROR's CERTIFICre that coreeoftNs consignment are 5A1•and am,,tely desotbed sbore by aha Proper dripping name.and are ciasdhed,packaged, <br /> marked and labe"aarded,and min all rasmde;in proper condition for Import according to applicable inlemajpreel and r®donel gotemmertal regulations.11 exppRsNipment andlamitne Primary � <br /> Expener-1 x"f Mal the CCMena of Yti cotsignmarR contemn b the terms of that attached EPA Acknoaledgmemof Consent. <br /> I tartly Val U.e xasle minimization sraternent idenbfred in 40 GFR 26221(a)(std ams large quan:.ry 3arronanr)w(1)(71 am a sea%quantity gercwka)is me. <br /> Gem�B7(y(tjgam(e Prime Name Sigrubn �T month Day Yea <br /> air LLQ 1I `v(� <br /> —t:,6 Intemafpnal SnipnenLe '�7 <br /> r—' ❑hnper foU.S. ❑"cz R hem U.S. Pot d emxm <br /> ryle . <br /> =!Tureporlar sgratne(for e.port only): - Dale leaving U.S: <br /> 17.Tra:+sponergdroWedgmmtd Rxeiplof Malanah <br /> M TranstrM Epetgg7ypad Name S)gnalure me* Day q <br /> Qrare Ipot'aa1�2 Ylwvelr �� SigteeYtrc M111 onth Day .,Yew <br /> sa,J �osr ( o <br /> Disaepan <br /> 18a 0iscreparuy indication Space Ouanmy ❑Type ❑Resdw ❑Perual ReledY n ❑Ful Rejection <br /> Mandell Relarenoe Nunba: <br /> 18b.gibmale Fadisy(or Geraato) <br /> J U.S.EPA N Number <br /> V <br /> LL Fadlly's Phone <br /> w 18c Signature a'Agemate Facility(o Gatemto) <br /> Montl) Day year <br /> Z <br /> H19.Nareardws Waste Report Management Medtod Codes(.e..codesfor hazardous waste treatment disposel,and recy6ng systems) <br /> 1 2. ' WLA A, lel <br /> 1 20 Despre ad FadlryOwnarw dr Ce fie bndmaipt iha c tel by he ma ndex eptwndadnlamfa <br /> Pdnledrfyped Name <br /> siprature Month Day Yea <br /> EPA Form 8700-22(Rev.3-05) Previouseditlonsareobsdete. DESIGNATED F I TY TO DESTINATION STATE (IF REQUIRED) <br />