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Please print ortypa. Form designed for use on eW9(12• itch)typewrites .r Farm Approved.OMB No,2050-0959 <br /> UNIFORM HAZARDOUS <br /> 1.Generator ID Number -Papa 1 or 3.,Rmergerlcy Response Phone 14.disaitest Tracking Nornber <br /> wASTEMANIIEST. .. CALrl�1f.d4 � 1. 7.r>r 0' 1 ." .. JJK .: <br /> 5.Generators Hama rynd Halling Address Ganerstar's SltaAddrass(if dtiferenIthen is' address) <br /> Crry OF MVrK.TnM Y 6Al NIOP.AL lWfe let F.f51N3r +1► iiV <br /> 2> 1'tWv t,MoTCi I TLIlI. : <br /> r: SIDUCT&I.Wk. 9: 9 <br /> GerreraWs Phots: U.S EPR ID Number <br /> 6,Transporlo'1 Cornpany .a <br /> RAW-elf-14ROMWE U.S.EPA ID Number er <br /> d0�?ti� <br /> 7.Trmtspmter 2 CampanY Nama <br /> 9.Oeslgnatad faulty Name and SKeAddrass U.S.EPA ID Number <br /> CIILhIIno"L U1►AM MAldkWMPr W, IV <br /> M1 OLID S 'I INE WAD � a <br /> Kbj"t'4,Mf,9ANtfa)%CA IWI= ` <br /> Felt es Ph": SM-22Z294 . <br /> ga 9b,U.S.DOT Desatption(indudnp RWw SNtop Namei Haiad Class.ID Miter; 1fl.Catrta4iais 11.Total... 12.Unll 93.waste codes l <br /> HM and P eft arnup Raw)) No, Type Quenilly NRNaI. <br /> a 1' fl�ia•Rt;�M.�'r�tOt7tJ9 t�Tf~ �Cll,ls�� I;tSfi�r.5ltyfl,� •. -�, <br /> W 2. <br /> mq- <br /> 4, <br /> 14. ons andAddi9on Information <br /> -Kqften To veM404M.. .40.0.1p: ' tt" ,.�tp1) Olt M 4171 � <br /> Special Hann Instnrcti <br /> A 9 , <br /> 18, GENMTOR'S10FFEROWS CMFIQATION:..I hefft&r IBre lhat the M*nts of fids calrslgnnrentarefulLY and aowrately d strove by the proper shlppir4g name,and are dasslfled,paclraged <br /> marked and labokm p wrdad,and are In aq respects fm proper condition for tnmspmt aceatding to sppllcabie h,terrraGonel and rational gayenrrnenta,,regrdxttoirs,tt Woit shipment and 1 am the Prkwry <br /> `F.npor,sr,I oar6hl chat Dia camerds of.9rls carietgnmenl cadogn�@,e:temts t>f 9na.atlached EPAAdcrtavdadgmenf oTCansent. ' <br /> Icartifythatthewas%min m6onstntamant�ldentilledIn4DCFR262.27(a)(Hlam alargequsntilygeiieretor):or(b)(f1amismallrprarrtltygertaraf4r)fstroe <br /> GenerUe <br /> a ipee Pdntacir yped N tun}a er'' Mo* Day -- Year <br /> = ' <br /> 1 S man (,(Ie <br /> O lrirport toU 9•. F ort"M U 5 Port of enlrylexih <br /> Trompsrtersignaturo(for mob orriy):. Dattr Leaving U.S.! <br /> T rler 1 PROM*merit of Receiptof hlat@rlala <br /> 17.TrensportarAriapwtedg <br /> raespo *no Y" ) x :tv <br /> Slpnefure � Nroritil Day Year <br /> �. <br /> HE77 <br /> 2 PdrdedlTYped Noma u::. 5igrrehne i. r Mont Oay.- Year <br /> .P -,, <br /> 18.01sdrepertg ..: • . . , <br /> ,8a olsc�epar,�y arNld tion space p cbddan9, Cly Residue' CI Parlfat ReJerBon C7 fan Rafe hr :.., <br /> 180.Alternats NdFq(or 0enaretor) U 1D Nu <br /> S EPA mer <br /> Fads Phare::. �t r: Mar19n aaY.. Year <br /> 19c. lAnatrgeaf ateFac>Ilty(r>t0enaralvr} � ,,.- <br /> t , I, 3 ' ._.h r i <br /> n �m9 spb�) <br /> y 19.HamsdouaWeate Flepo►t Ma merit Aietlrod Cadea(f,e.,mdse Tor liaaardoua waste treatment;disposal,and . <br /> ru 1 12. <br /> a <br /> 2D.DeslgnatedFaci8ty0rmerorOperata Coacationofre"tvfhmmrdwsrtatodalsco eredtiytherimanlrestew:eplaofnetO16A 155 <br /> Pint d oma � Mordit pay .Year <br /> EPA Form 9790.22(Rev.3-05) Previous editians are obsolete. GENIERATOFIi$INITIAL'COPY <br />