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r <br /> Please Pill or 490.(Form designed for use on elite 12-pitch) dteL) <br /> 1.Generator iD Number Foran Proved.OMB No.2050-0039 <br /> tl[UNIFO.M HAZARDOUS .G _ 2.Page i of 3.Emergency Response Phone 4.Mani est Tracking Number <br /> WASTE MANIFEST (_ A Dq y 2-50 Z 1 ) - �?, v �J,�, '� w�,�.7.�'w�j JJK <br /> 5.Generators.(Janle rd A� Generators Silo Address tit different them ntapng eddn., <br /> d vl� et'S <br /> �oJhe�l StreeP 1lru+ 't_.aC, . :�;,'�S <br /> yi,r.1,-I,,- c tofu o qr) x , ccoir moo' <br /> Generator's Phone: l Fal! ,�2 W 't-r7C- '�'{Oi'1 �,^.A QL.) <br /> B.TanspoM1ar 1 Company Name <br /> U.S.EPA ID Number <br /> HaZW' ; -ais. hi C A T 0 8 L 0 1 2 8 0 0 <br /> 7.Transputer 2 Company Nemo <br /> U.S.EPA N Nurdwr <br /> 8.Designated Fadiy Meme and S,,Address U.S.EPA ID Number <br /> oras"& J,,ptir T <br /> 1630 W 17th Street <br /> Fad L �p Beach CA 90813 <br /> 9x. 9b.U.S.DOT Descnplion(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers11 <br /> HM and Packing Group(If any)) No. Type Qua.Total otalntity W12.t.Unit UnR <br /> 13.Waste Godes <br /> ' Ne) ire-A ror5uj klS <br /> Z <br /> 144 <br /> w Z. <br /> k. 3 GT UNITGiv4cllc • hJFotnlprIii ! JSJ <br /> rT{4-(t` K T99 !1 Lx7t�Q� h1 O > <br /> 4. <br /> iryd, i Handlhg Inslmeum andAddleoral Information <br /> 4ilo""4 V.J(x 1 I' 1 ,4`t I. , <br /> 13>( If'uCR L)!OI f/`r 'fr "Ill"1;<a <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described shove by the Proper shipping name,and are classified,packaged, <br /> marked and Iabelecirplacarded,and are in all respects in proper condition for transport according to applicable inremationaland national governmental regulations.It expel shipment and l am the Primary <br /> Exporter,I certify that the contents of this consgnm rit=form to the terns of the attached EPAAcknowladgmenl of Consent <br /> I c ify that the waste minimization statement ideniJged in 40 CFR 282.27(a)T I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generators/Offerors Pnnted/Typed.NamsMI Da)y J / Year <br /> --r 18.peematldlal SNPnmrll% <br /> _ ❑import to U.S. El Bow ham U.S. x, Pod of enhylexu <br /> Transporter signature(for exports only): Date leaNng US.: <br /> w 17,TransponerAchnowlleedagdment of Receipt of Materials <br /> Tile' 1HdRl; Namr Month Day Y <br /> { 7TMMPM r 2 PdnWTyped Name <br /> -1Sl9ndure tdonth Day Year <br /> iB.Discrepancy <br /> 18a.Discrepancy Indicalion Space <br /> ❑ Quantity ❑Type 1-1 Residue ❑Partial Rejection El Full Rejection <br /> — <br /> "Sill <br /> ID711ERE710ED WASTE WAS NECEii HANDLED AND STORED FOR SURSEQUIll OF"II1 <br /> NSill 7RFAT111i qS RLUSE QOSa ��, TES THE FACRul ONDFS <br /> iSb,Alternate Facility(or Generator) WrtH THE:FNYQONSRNTAL PROTECT1UN AGENCY IN ACCORDANCE <br /> OF <br /> V P1!RP20lIRCE CONSERVATION AND RECOVERY ACT M IaIF TOCEI}FSL weed AIRICARIE <br /> sa <br /> Fail Phone: FOAL AND STATE REMLAn#Ns, Ot*59Y a OVERTON HAS ASLfp THE NF,lF3SARY <br /> nR LMM TO ACCEPT THE REFOENCED MASSE AND ALL ilt MASri , a13!JI NAwo1)y <br /> 1So.Signature of Alternate Facility(or Gemerai OMDLY Month Day Year <br /> Z <br /> Z <br /> y 19.Hazardous Waste Repel <br /> Management Method Codes(I a.,codes for hazardous Waste treaMeni dlSposal,and recycling systems) <br /> G 1' <br /> 20.Designated Facility Owner or Operator:Certification of recelpt of hazardous materials covered by the manifest except as noted In hem Ise <br /> PdntedlTyped Name -_ <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete,_, OE-SICII`ll FACILi'fY'TU G; hI'-;4:;STOai <br />