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ate/Time FEB-02-2009 (MON) 16:20 P. 093 <br /> _ zb 02 2009 4: 29P9 ASERJET FAX P- 3 <br /> f., <br /> Please primtor tyle.(Form designed for use on elite(1&pdclr)�ypeKrAer.) Form Approved.OMR No.2050-0339 <br /> UfIFORM HP2ARDOUS 1.Generator ID Number 2.Page 10l 3.Emergency Response Plane a.Merrill Tracking umbo <br /> WASTE MARIFEST aq•$ 4.6 ill 003567534 J J K <br /> 5.Gen sNameaitl M_, alarg Rddless,ail Generakes Site Address(d d'Alerenl Nan mamng address) <br /> 4343 East fF'IO airgBlf7 t�Al1gf16F <br /> SEoDIdW,CA 05215 <br /> eneramrs Pbwc: 786546-0111 <br /> 5 Trarupmer 1 CnmpamyName U.S.EPA IO Number <br /> CtlllwrNe Eff*unmertel8 Litho CAROW0099910 <br /> 7.Transporter 2 Company Nam U.S.EPA m Number <br /> AsbuYEmiormeiSorvlces CADM77M <br /> 8 akd Faolibp'��y�ar�eapp S�} Address U.S.EPA CO Number <br /> WeOBf I�CtT1pI ;" <br /> 5375LosArlge CA CM8070 IM <br /> Faoli sPhmne. 373-777-15M <br /> 9a. 91 US.DOT Description(including Pmpar SNppeq Name,Haaerd Cless.D Number, 10.4:4ntainam11.Tata) 12.Ung 13.Wasl9 Codes <br /> HM andPddVGmup(dany)) No Type Duanely WIN01. <br /> I' NonRCRAflazendouswaste. itQUM(waste011) G 721 <br /> l / U None <br /> w 2. G <br /> 3 G <br /> 1 <br /> 14 Special Handling Insnrc ions and Additional In owl"on <br /> e.Weds 01 —]10() ERG#171 <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION: I heresy dedan Nal the comems;of Vgs oonsigmsent are fully and accurately oesusbed abme by the pmpershlppng name,srd aro classified.packaged, <br /> marked a.M'abeledylaremind,and are nag respects in proper xrxhun for banspod acccrding 10 applicaee nlarmil land national go.e mef regualiors.It exon shiprresl and I am the Primary <br /> Evader.I canNy tWt the comema o`Nis consignment conform to the terms d the amarhed EFAAcummilmignal al Consamt. <br /> I arMy that line wase m unnizatbn slelement idenM1lNd in 40 CFR 262I7(a)(d I am a large guanldy gurtralor)or;b;[II am a smart gcepydy geneiabr)rs true. <br /> Genera'. "eror's Pri dedRypeo Name Sgra Month Day, year <br /> aLL -- <br /> 15.InL=r.-atonal Sh'gmerds <br /> ❑Mcad loUS. ❑Eaoom rVa. Pryl el enlryle- - <br /> z Trarsspmer sgaature porexpoda only): Dawicarmg 5 <br /> w 1],Trznsporlm Ack Medgmerg of Rei of Mamdals <br /> Trens~ ed Nemo Sgnawre Monty Day Year <br /> 0 V <br /> h <br /> Q Transporter Proei Na Signore Muth Day Year <br /> 20 <br /> } 18.Discrepancy <br /> 18a.Disaepancylndiatlm Space ❑Cuanlity ❑Type ❑Residre ❑Partial Rejection ❑Full Rajeci <br /> Marvlesl Reference Nur*a, <br /> 186Anemate Fadiy(cur Generafd0 U S.EPAID Number <br /> J <br /> U <br /> Fadl'nys Phone: <br /> w <br /> 18,Signalum of Alternate Facil(or Ga..*) Month Day Year <br /> f— <br /> Q <br /> z <br /> N18.Hazardous:Yash Repom Management Meisel Codes Ge..codas V haausmus waste basement,disposal,and recycling syslams) <br /> � 1. 2. 3. <. <br /> 20.Dedagi Facgity Dma or Operator.„erlifiaWn A receipt of hazardous mateiata covered by the manifest except as rood n V.18a <br /> Prieto yyai SgnanshMonth Day Year <br /> AZ <br /> 0-3140,316a <br /> EPAF0rtn8700-22(ReYA 5) Previousedilionsamobwlele, DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />