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"' "" •" ��,v,.a �,,. , ,V,nuv„�ul vv, vLL vvvv I YJY I VVV I/VV IL I VVV <br /> Please pdnl or type.(Form designed for use on elio-pitch)typewriter,) • Focal Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1,GeneralorlD Numhcr 2.Papetor 3.Emergenuy Rssponsc Phone701343 <br /> 4.tdanifosl Trach np Numhor <br /> WASTE MANIFEST CA=W877 �D 013 4 3 5 2.6 2 JJ K <br /> S.GaneratoraNema and M918npAtldress Generelafs3kleAddras(F diNsrant Nan reading address) <br /> C PACIFIC sourhWEST IRRIGAnoN <br /> 8372 S..(ACKTON RO- <br /> STOCKTOK CA 95215 <br /> Generators Phone: <br /> 6.Tmnspaa;l campa9y Name U.3,EPp ID Number <br /> George W. Lowry,IRO. GAR006047019 <br /> 7.Trsncpodar2 Company Name U.S.EPAID Number <br /> APR 0 8 2015 <br /> 6.Des�i gaeqq F��gppl�,pyy N,�M��pp��S5it ddrese U.S.EPAID Number <br /> c:K�A &�triT17N9(NC. <br /> 1610 W 17tH street r��VIRONMENTA CAOC2SM12 <br /> LONG BEACH,CA 90815 t_IHFq;THDEPARTMENT <br /> Facllilv's Phone: 801)wSW-67�gr ' <br /> gg I 9b.U.S.DOT Description(Nducing PropsrSNpping Name,Hazard Clan,ID Numbs, 10,Comainam 11,Total 12.Unit <br /> HM and Packing Gmupffany)) No. Type Quanh'ry WIN4L iS,Weals Codes <br /> rr X 11' UN IS23 WASTE FLAMMABLE 1nau1O n. o,s. (AOetorq 3 PG11 ' DM � G 2 0001 <br /> o iii) <br /> m 2. 3 `J � <br /> 3. <br /> 4. <br /> —,1 14.Special Hsedllryl Instructions andAddilioned Information <br /> C ERG#128 AcetotlePVC plpe.ptlmer PROFILE# �WJ �� IfgVO1CF;7 �r (�,�j <br /> USE GLOVES <br /> 18. GENERATOR'SIOFFERORISOERTIFIOATION:Iherebydedare QuAthe contentsoflhisconslpnmentare fullyand accum(elydowribed above by lhopropershipping mme,eN areefass7ad,packaga0, <br /> marked andlabeledyplacarded,landam in agmspamS lnproparcondilion for trampon according to applicable inlema8onelend na8onelgovemmenlalieguh8ons.Ifaxporistipmeal and lam the Primary <br /> EXpone,l aemymel the contents ofthis conslgnment ennfonn to The terms ofthe attached EPAAdmoaiedgmonl of Cansenl. <br /> I cedily1 at Na waste minimize8ansmlemenllden8fiedin 9d CER 282,27(x)(If l amalwile quawkygemmto.)or(b)(Il a1n a smell quanGygenemtor)Is two. <br /> Genaratots/ONeorsPdniedllyped NamD Signahue Month Day Year <br /> J 16.t1emationel SNpmonts <br /> �- ❑Impodhe U.S. ❑Expodfmm U.S, Podorcnlry/eldl: <br /> s Transporter signature(fore7veod9oriW: Date leaving U.S.: <br /> W 17.TrampodwAc%nok4edgmenlofRecelpt ofMatedals - <br /> a Trump oner1 Pon//tee�g��,,pp Name Sigmlure Month Day Year <br /> a l..v1 <br /> Tmmpotter2 Pdnledriypod Name Slgnalum month� Day e Yew <br /> i <br /> 18.Disorepency <br /> 189.Discrepancy lndieaucm Space ❑ Queary ❑Type <br /> El Residue ❑PanielR edion <br /> aJ ❑FWIRsjsc8on <br /> Manifest Reference Number, <br /> 18b,Alternate Factliry(of Generator) O.S.EPA ID Number <br /> J ' <br /> U <br /> Fecdily,Phone: <br /> 18c.Signabue ofAhmanste Faclgy(arGvmrator) _ <br /> F, _ Month Day Year <br /> c <br /> `y AHazardous Yrmlo Report MamgemenfMothod Codes pe.,codes For hazardous Yrasle treatment duposel,andresydingsystems) <br /> I. tt` 2. 3. q, <br /> 28.Designated FaadlityOOane1ror Operator,Certification of recaiptafharardous materials covered by No nll ceptasnoedmllemlBa <br /> Pdole Name N jS1rAatW6jo -GYYoar <br /> EPA Form 8700-22(Rev.3.06) Previous edilions are obsolete. DYSKOATE YO 6EStINATION STATE(IF REQUIRED) <br />