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Please prirtt o:type.(Form designed for use on elite(12•pi(c,h)typewriter') _ Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1, JO Nunirer 2.Page 1 of J.Emergency Response Phone 4 Man0st Tracking Number <br /> WASTE MANIFEST C��DD Z`+�p9 1�g 1 1-800-424-8300 013481343 JJ K <br /> 5 Genefaia's hams and Mail ng Addres6 Generalor's Srl9AddrGSS(d drlfunanl man ma V.9 address) <br /> ONSF Railway Co. <br /> 740 E Camaaip Dr. ?7 <br /> SanBernardi;tc CA 2240" STocKTatil Sc�aD1�IS/ate! <br /> +;vrxrata'c Phe:o: 9 0 9 3 B..6 4 0 6 ' 5T0C r_-r /,1, 04. 95 20(6 <br /> 0 Trmispodc r 1 Co n;my Nama <br /> U.S.EPA ICt Numtcr <br /> EtrArii3nmental Logistics, Inc. C A R 0 0 0 2 1 7 5 1 3 <br /> 7 Tiansporler2 Cnmpany Name U.S.EPA ID Number <br /> 8 Uasign3ted Facii f�lamo and Silo Addie9' U.S.EPA 10."lumber <br /> Crosby E Overton <br /> 1830 W.17th Street <br /> Lorrg 9eaoh CA 00813 <br /> Fac,dys f-%wjo502 432-5445 IC A D 0 2 d 4 0 9 0 1 9 <br /> ga, 9b.U.S.DOT Dssmr4 on(uo:'ud ng Propel Shipping Narita,Hazaid Class,10 Number, 1U.Containers 11.Total 12 Unit <br /> HM and Packing Gtoup(B any)) 13.Waste Codes <br /> No, Typo Ouaniily Y1tNol. <br /> cz Yi-- IUW325,VASTE Flaninabte solids,organic,n.o.s.,(gasoline),4.1,PG <br /> o lI y D0(031 10018 352 <br /> C; OM SOO -..-.... _... .........� _.-.... <br /> P <br /> U-1 ; <br /> i <br /> _ l <br /> r <br /> 4. <br /> l s;. ialHandlinglnsuuctxrrs rJAdd�i,raill om,ativa f)(),E)Ba(Iasts,Rock,Soil Contw/Gasoline (2):55)ERG#133 W�Or`#QM5697 <br /> Er-tf.�.Gy.,,c y /2�Sla.�ti I G fF��-itE C !—Srpo-i/zY�3�o CC�tI(��o SZ3 2„ <br /> 15. <br /> GENERATOR'SIOFFERQR'S CERTIFICATION:I hereny decfafe,that the contents of itas consigranarll are f0y and aauratsly desalt ed at:os`e by gin fqaper shipping name,and are dassiried,paci,aged, <br /> nIaAed arud lafw_'edfpi.,^.;rdcd,end ate in all respells in praper mndg!on for transport axwdhg to apPktabie internallmal amJ national governmental regwasons.11 airport stupmanl and I am Ute Pnmary <br /> LKponer,I cankhy that the contents of INS mnsignment aonfurm to(be tomre of tho aftadttid EPAAcluxnVvdglnanl of Consent. <br /> i rr-A fy thal Ura was4 mm!miralwn stalornonl identified in 40 CFR 282.27(a)ht I am a large quantity generator)o;(b)(if I am a smak yuanlity nenaralcal is r ,. <br /> GenaratorsdOfkrcts PnntedTy;ed Name ��D Slgnalur., Q O tQNSF t onlh Day ear <br /> �s w�� /I's F 3 30 �s <br /> -� IS.JMM nal tterlL=, <br /> 2 ❑Irn;ort*.o U.S. ❑E%Port Iron US. Pon of enliy;er'l: <br /> — - - ---- <br /> Trartspwter signa;ura(I.x exports on'ry): Q31e 1aa✓ny U.S. <br /> � 17.Tiansfarl�.Ac+n�,v;cdgmc-nlotRauiptolMabriats <br /> w <br /> lians;wte Ind.Iyped"lame Snature��� Mongi Day Year?� frinsparter 2 PmdudlTyped Nems Srgnn urr. <br /> Month Oly Yrm <br /> t- 1R Discrepancy <br /> ice Discrepancy Iod1"MIL l Sf-ace I �1 <br /> L_ Quantity ❑Typo `-�Res;dua ❑Partial Roedion I Fu I Nedion <br /> Vw0est Reference Number: <br /> 184 Allernale Fa6lq(or Ganeialor) US EPA ID Number <br /> r <br /> V <br /> U.1 ISi y;ialwa !Aar:na6i€ac4ry(orG iiera!)i) monih Day Yew <br /> Q <br /> z <br /> 19.Hazardous Wase Rapo;t hsarcrgert"t Mothod Codas(i.e.,codes for hazardous wwe treatment,disposal,and recycling systems) <br /> L/ T <br /> I <br /> 20.Des1g1 FacNlry c vzrtar or Operator:Ccrtti ,an of fectdpt of hazefdvus matenals covered oy the manrfeal except as roved in lltim i8a <br /> P,intedi typed Nap, I Signature Mon--Day Y� <br /> EPA Form 8700-22(Rev 3.05) Previausedilionsareohsolele DESIGNATED FACILITY INgTION STATE (F REQUIRED) <br />