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03-04-'15 15:52 FROM-00les Environmental 661-322-88810 T-454 P0009/0012 F-956 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter,) FolmApproved.OMS No.2050.0039 <br /> • UNIFORM HAZARDOUS 1.6e9oratoc IDNumber 2Pago,of 3.Emergenry Reeponsa Phone d.Manifest TmokingNumber <br /> WASTE MANIFEST CALOGD35fiFny : .,( ,, 013435267 JJK <br /> S,GeIR37CI s NemoOUn-fling Address Generators SifeAddrese to c iaerent than malling adaressj <br /> PACIFIC SOUTFWEST IRRIGATION <br /> &372 S.JACKMfU RD. <br /> STOCKP]N,CA 35215 <br /> Gshare mraPhone: 209.d6POdSD <br /> e. <br /> PD at 1 Compang Nam¢ U.B.EPAID Number <br /> George W.Lowy,Inc_ QAROD0047019 <br /> 7.imnAsnpaader2CtmpanyName _@9 C <br /> p US.EPAID Number <br /> a and <br /> B.Deegne <br /> [; ou�'BY r&NpvEFtTQpJ U.S.EPAW Number <br /> iM0 W 17th Street CAMMU 1.9 <br /> LONG sPAcH,cA 9081s <br /> FecifilyaPhone: SOM7-6M <br /> Da, 911:11•S.DDYDsscdpg¢n(ncNding PlaperShippingName,Hazard Cress,IDNumbe, 10,Containers 11.lbral 12 Unit <br /> HM and paddng Group(ffany)) 18.waste Godes <br /> No. Typ¢ Quantity WMNoI, <br /> o •X 1' UN 1133 WAS71;FLAMMA13LE LIQUID n. o.5. (AgheeNea) 3. PGii I DM p� t3 D00, <br /> 3. <br /> AP 08 2015 <br /> d. <br /> C VIR <br /> r r_yTr neon r�aee <br /> �._ 14.5poetal HandlinglnaeoegonsendAddigonetlnfamedon <br /> ERGV126 Torahydrohlfn&Meihyi Efhyl Ketone Pm Alpe glue <br /> USE GLOVES PROFILED INVOKE'# <br /> 15. GENERATORElOFFEROWSCERTIFICATION:Ihefebydedare That the conienls of this consignmemara filly and arNmtelydcs0bad above by the proparahipping name,enlaa dessi9ad,packaged, <br /> marked and labolodlplacardad,end ere in agrespaem fnpmparmndgon for bensponee:ofdfng to epp8eable intzmsdonelendrregonalgowmmenml mgulagons.IleXp¢dohlpmsntandtam thcpdmaty <br /> Expoder,i"*thatthe Wnienls offt mnslgnmentwnfmm loih8(ormsol Naanached EPAAeknoWedgmentafconsenL <br /> I ceditythat thawasle mfnfmrza9nn statement ldentigodin48 CFR262.27(s)fdl me a ler9e quanglygenemtor)Oro)(ffam asmg quanit sicns2tor)fsbue. <br /> GenemmrslONerola Prrnledffypad Name SignatureMonth Day Year <br /> a. e5-7,t ' Ra�U s <br /> F 16.InIemaBonal3hlpmenm ❑Impon to U.S. ❑ <br /> Epottfmm us. Pod l <br /> irehspodarmgneue Data leaving U.S.: <br /> 17. <br /> TmnvonerAOMvlodgmentofRemiptofMeledals <br /> iranspoder, rinl yp Nup, signature aQ. g Month Day Year <br /> s Tmnspcmer2P pad Name �S <br /> � sig"m11B Month Day or <br /> a <br /> r— <br /> .I. 18.Don r paney I r—I18a,DisaepancyindwaloiSpace El Quantity ❑lwe EResd. <br /> ❑Penial Rejection LI L1Fu11 Rejection <br /> 18b.Atlemale Facmry(Of Generator) Menil'ael Rammnse Number. <br /> U,S,EPAID Number <br /> U <br /> a Rcluv5Phone:' ' <br /> 18¢.SfgiralureafNkmalefadbty(orGenemlot) Month Day Year <br /> .Hazardous frim ReporlMenegementhleBwd Codes(,e„code's forhazardous waste treatment,disposal,and recycling systema) <br /> I. 2 3, q, <br /> 2D.Designeled F�aoL(y GYmgratpperalac Cetb7rag¢nofYsmiplofWzardausmatedab covered by Thema a ptasndedinllem,8e <br /> We ad Name t ure <br /> 9 Month ay Yea— <br /> I'SIP <br /> EPA Form D700.221Rev.3.05) PreVlean nd8fnnn nrw„hmlote <br />