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Pleaae print or type.{'Form designed for use on elite(12-pit^i,7 typewriter,) <br /> F <br /> HAZARDOUS 1.Generator ID Numher 2.Page 7 of 3.Emergency Res Form Approved.OMB No.2050-0039 <br /> MANIFEST ` y Posse R-� I.ManNast Tracking Number <br /> Ys Name antl Mailing Address 1A -- a _ 00117948 FLE <br /> Generators sienmailing address)Taarisaat� Systems LLC ry'South Stoaabctoao btreet Ca- 95244 <br /> Phone: ?003((A—RRR1 <br /> er 1 Company Name <br /> AdsancedU.S.EPA ID Number <br /> Cheeeical Tram,o0at <br /> 7.Transposer 2 Company Name " -: . .[� 0 q <br /> U.S.EPA ID Number <br /> 0540 <br /> B.Designated Fadlity Name and Site Atldress <br /> Sxteoexes Voter Technologies Carp- U.SEPA ID Number <br /> 5375 South Boyle Ase <br /> Los Angeles, Cdr 90458 <br /> Faciliys Phone: 323-277-1500 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, CAD097030993 <br /> HM and Packing Group(if any)) - 10.Containers 11.Total 12.Unit <br /> No. Type Quantity M.Nol. 13.Waste Canes <br /> 1.Waste Potazsim )>tydrowide, solution, G, <br /> o y BH1614, FGI2 D002 122 <br /> 2 <br /> c� <br /> 3. <br /> 4. <br /> 14.Specal Handling Instructions and Adtlitional Infomatian <br /> 2) L" III: 1-S4; P188043:; TES_ <br /> Project number: 26009 \ ,p <br /> 15. GENERATOR'S/OFFEROR'SCERTIFICATION: Ihereby declare Nat thecentenLsofMISconsignmen refullyyyaand ccumteF—Yed bboveb the a G <br /> marked and labeled/placardetl,and are in all respects in proper condition for he ng pp Y proper shipping name,end are classified,Imhe primary , <br /> rlspdn attached <br /> E a applicable intematio Consent national governmental regulakau.Jf export shipment and l am Me Primary <br /> Exporter,I certify that the contents of this consignment cenfonn to the teens of Me attachetl EPAAcknkrwledgment of Consent <br /> I certify that the waste minimunakn statement identified in 40 CFR 262.27(a)(#I am a large quanfi <br /> Generatoes"eroYs Pen _ yped Name tygeneretor) (b)lift area small quantity genetator)Is4rueil1 - <br /> y r i9n ear <br /> F 16.International Shipmenk <br /> 4 <br /> Z ❑Importm U.S...: Q.Export from US.__ Pat ofen"Int <br /> , <br /> Trans iter si nature for ex ds only): ^� - <br /> w 17.TranslraterAcknoMedgment of Rebeip(of Maws Date leave U.S: <br /> OTransporter.l Printed/Typed Name _. gnat <br /> N ^ on y egt <br /> W k,Q Transporter 2 P.....N,yped Name U f1 M I07 <br /> F _ _ ay ear <br /> 18.Discrepvlq Came <br /> i16a.Discrepancy Inclination Space <br /> ❑ Quantity ❑Type ❑Residue El Parfet Rejection ❑FUII Rejection <br /> 18b.Alternate Fadlity jor Generator) Mangest Reference Number <br /> � � .. U.S.EPA ID Numher <br /> U <br /> Q <br /> LL Fadli s Phone: <br /> w 18c.Signature of Alternate Fadlity(or Generator) <br /> ZMonts Day it <br /> h19.Hazardous Waste Report Management Method Codes(IY.,codes for haze <br /> 1 _*us waste treatment,disposal,and reading systems) <br /> W t <br /> 7 \ <br /> 2. <br /> .- 3. 4. <br /> 1 20.Designated Facility net or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> me <br /> Pnntetl/Typed Na <br /> Signature Month Day Year <br /> EPA orm 8700-2 (Rev.3-05) Previous editions are obsolete. � r •�- <br /> DESIGNATED FACILITY TO GENERA R <br />