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# � ,m�� � .^n. - m�. .**'"I�IIINNIIIIII�INUIINII � � ININI�IN Form Approved.OM8No.20500039 <br /> +�. trte <br /> `Please pont or type.(Form designed for use on elite(12-pitch)typewriter) <br /> UNIFORM HAZARDOUS t.Generalar ID Number 2.Page ip/ 3.Emergency Response Phone 4.ManHest Tracking Numher FLE <br /> WASTE MANIFEST ; �.Il 007245 <br /> S.Generators Name end Mailing Ad rens enereto site A dress(d ddferent than mailing address)` <br /> QtFr! 736110 HeSll�'+' <br /> f T=l d b a Y.' 4 r,:r.� P Ra Ida <br /> � Rd <br /> Gl r� Is <br /> ' akA.`�.;1, e I � At='Y r`1 Sg"2f1R <br /> Generators Phbne2. '..I)3Ytil „'' �.`: . •�':. -. <br /> U.S.EPA1D Numher <br /> 6 Transporter 1' ompany Name - <br /> P+et t?N" 4 a<r9t� <br /> 7 Transporer 2 Company Name, U S HPA IDNumber <br /> rVI�N �. A i- r� �. <br /> 8,Designated Facili Name and Site Address 1 U.S.EPA ID Number <br /> g N )"1-r C daA:'4C,(it3�' rfVdCun, 1110. <br /> 160 W. Monte Avenue <br /> 'Rialto. CA 92316 <br /> Fachl sPlockar <br /> q Ext - t'At 324 4 <br /> 12.Unit <br /> ga 9h.U.S.DDT Descriptor,(including Proper Shipping Name,Harare Class,ID Numher, 10.Containers 11.Total 13.Waste Codes <br /> HM and Netting Group(11 No. Type Quantity WtNol.. <br /> 1on hazardous Tvaste, at id (Paint) 181 <br /> z. <br /> W <br /> 3. <br /> 4.,. <br /> 74—S Hentllilg lnsWd'ahe and AddAional Information �,14U72313 lAfil IG 1 4-- <br /> One Or m0f¢UI the mataflai IlSted On tnle rnanlreet may <br /> P >f313 0?,bU1t 3 i 1x55? be recycled as afterintlatIve dally Cover(ADC),or other <br /> method which Uses-G terfal In0M land <br /> Jab #33H22. k!u <br /> 15. GENERAT-051OFFERORB CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the propershippmg name,and are dascged;packaged <br /> marked and Iabetedtplacarded,and are In all respects in proper cuntleon for transport according to applicable International and nadonal governmental regulators,If export shipment and I am the Primary <br /> Exporter,l cedlfy that the contents of this consignment conform to the terms of.ldeattached EPAAcknowledgment of Consent. <br /> I certify that the waste minim statement Idmtilled in 40 CFR 201i(a*16alaido Quant ygvheretor)of p(it I am 0 srpall guarAty generator)is hue. <br /> nion ay ear <br /> eneretdr e s n ni arae r { <br /> rI. �} <br /> � 16 lnmir ational hipments r,�Txpdd(rom U.S. Pal of enay/e>dc, <br /> Import to U.S <br /> = Trans orter sl attire fa exports on 'fete lean U.S: <br /> W 17 TransponarAcknowledgment of Receipt of Matenals lig on ay cur <br /> rano rter1 Pdnt Ypy��air <br /> Trenspoder2 PtlnledRype .Name Ignature <br /> M —y TOUT <br /> Moo <br /> H <br /> 18 Discrepancy <br /> 18e Discrepancy Indication Space Quantity EjeT �p F ' APartal%edion Full Rejection <br /> It a <br /> S.EPA ID Number <br /> ieb Aaemate Faclliry(or Generator) ��������� <br /> V <br /> LL Facili sPhone: Month Day Year <br /> W I8c.Signature of Alternate Faorty(or Generator) <br /> a19Hararoous Mstafaport Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) 4 <br /> II. 20.Dedgnated Facili�OOwneror Opemtor Cedificabonofreceiptaflanardous starts coveredbythemanife a of as noted in its 1aafia <br /> Ye <br /> 1 PrintedrTyped Name 4' Sig <br /> f <br /> c" EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. - DESIGNATED FACILITY TO GENERA' R <br /> B700-nA coi_154 (Z189449,.� Su D79384 f Md18009ui PDJY�S�k �8D <br />