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Pease Drint or type (Fa—designed for use or,elite 112-pitch)typewriter.! FormApproved Approved OA1d No �G�O G03� <br /> UNIFORM HAZARDOUS Di° Or 10 Number 2 Pape+0t 3.Emergency Response PrtOre 6.Manifest Tracking Number <br /> WASTE MANIFEST fARaoo .2�7 g� -80o - 6?�-1/73 015482451 JJK <br /> 5.Generators Nartte and <br /> CC17'Cc Cv/IalrlA/Address l (�arte>etors Site Address;i different roan maikng aodress) <br /> .vo 3f� <br /> 3107 ErCr NAWIr Cec.rrj72"2VC /E/E Him.hee- LAr'C <br /> CRr/,s 6At/, CA 420de J C /r?At N, CA Ys.t r c <br /> Generators p.. ) 3a_- 27-S <br /> 6 Transpcoer 1 Comosrty Name <br /> �A/h0f �Nvl� N US EPA!DNmber <br /> o /ht's✓ �� J-elvx G eCA�C,Sj�f f 7 � <br /> JT,;arsconer 2 company Name <br /> e U S EPA ID Number Nle�! , <br /> , r l Nt<y <br /> 8 DeKrwted Facility hare!and Site Address -,S EPA!D Number <br /> iP//o ch'Ea7/ «< <br /> Sc,.u /1'.1 A'yr- ,4f <br /> FV/ewcoJ� CA gc3cl <br /> ,Ptana: _23 ) -276 -1.233 C�Dco8364`-`7'�3.� <br /> 9a go,U.S.DOT Des ,Poon(mcltrmng Proper ShM-g Name Hazare Casa ID Numovt Toyi 2 Uric, <br /> and P800%CrOUD(if any)) r.r, Type Quantity WUVd <br /> o <br /> ' VWU03, 1,/Ajft GR_joI;Ne,A;xtvlel3, _ <br /> Q I Om 2S DOC1 33i <br /> Dais <br /> W <br /> W <br /> C� <br /> i <br /> I 3 <br /> a <br /> 114 Specal tw,Cong insnW Lcns and ACCrC":pI= �EA6Z8 (FRG BolGC/,;) (veR rf <br /> A,? �eYYW -00 <br /> ✓�^ / <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereLy declare that the contents of Un=is;grien!areVy arc acarateiv aescribec above by the orcper shipping name.and are lass hod,packaged <br /> man ec and tatx p acarded,and are u a1 respects in proper condition for ranspor,according m applicable�nterracnnal and,abcral x•.ernmenta,eguiabofis it expor,shipment and I am the Pnmay <br /> EVorw.I artly met the contents of Ihrs consgnrnert conform to the terms of the attached ESA Adviowl <br /> edgmerc of Corson: <br /> txrhy aat to waste n,, uzator stammer•rler,!iW, in 40 CFR 262 27!a)(R I ar a:arse MuanMy genet;-- ^ bf of f ama smau ,.a <br /> Gere2a%s'OBero�s Por;e�'.:ec r.ar�e - v" � rea true <br /> ue <br /> jr Matin Day year <br /> �J 1e riternationa!Snipments — <br /> Z U Impor-to L S b Wt ttom U S Port exit: - <br /> Transporter signature(for exports onty) Dale leaving L S — — <br /> W 17.Transporter Aciawmedgrnertt of Receipt of W. -ois <br /> Trarsporer 1 Pnntedrryped Name <br /> S gnahae Month Day Vear <br /> CL <br /> Q T 2 PrMed? me <br /> Sig r^ Nonth Dav Year <br /> 1 18.Discrepancy <br /> I i Ida Discrepancy Incication Space 1 <br /> Type 1 Rescue —i Partial Reje tcc ❑"Lill Rep-.nrx. <br /> 18b.Alternate FaClity(or Gertaator) hlandesl Reference Number <br /> U.S.EPA ro tJtmber <br /> U <br /> =a IRf s phone <br /> w <br /> 'Sc S grature of Altemate Fath ty ra Geoeraton Month Day Year <br /> 2 <br /> C r 9 42zardous Waste Raw.Managen+ertr Memod Codes rr a oades fY hazardous waste bealrnmt dmposai,and recycling systems) <br /> rn <br /> W <br /> 2 4. <br /> 20.D"-ed r'aarty Owne•or Operator Cerohratron of'eceipi or razardous matenals covered by the manifest excim as nrMd m nom l a <br />