Laserfiche WebLink
Please print or type,(Form designed for use ort 01110(12-pitch)t ewriter) FormApprover!.OMB No.2050-0039 <br /> UNIFORM HA7rARtlOUS 1.Generator 1D Number 2.Patio 1 of �.Emorgancy Rosponsa Phare 4,EtanHost Traaklng Num or <br /> WASTE MANIFEST _I i }7gq i s 0 0 9 9 2 Z)U 9 5 JJ <br /> 5.Generator's Name and 6 tlq Address Genaraloi a Site Address(4 411twonl than Insi'Ing addross) <br /> VAPIPERLWID AN12,S'O'PS INC, <br /> 1320,S.SaCraraei to•St. <br /> G e�ralors So Il15"" L oal,CA 95240 <br /> b,Transpetior t Capri M,S.EPA ID Number <br /> 7.Transporter 2CompanyNema f rl 1At G t^ann` rr �— <br /> ,✓� U.S.EPA IDNumber <br /> &Doslgnoted Facflily Name and Silo Address U.S.EPA ID Number <br /> Vi—=CLIA ES TECHNICAL S Wi ONS, LW, <br /> i iP5 HENSLE`/ STREET CAT05001407 9 <br /> "RICt•lt:dr�f7r�';X:F, 9d6(7I <br /> Faclllty+s pitane;Q n <br /> go. W U,5,DOT Descdpgon tinctudtng proper Shipping Name,Hazard Crass,rD Nu year, 10,Centel, els 11.Total 12,Unit HM and Packing Greup(ft any)) No, Type Quantity. Wt./Vol. 13,Waste Codes <br /> t. S <br /> Uhl302, .VY.ASTE EEf{J1ftOAlft}EAI7k11' HA2i+itDt3t14 . l!BSIA14CES, r` 181 p7Q6 r <br /> SD'D'9,PGIII(BEAD EL A$T) T <br /> : <br /> L t <br /> f t <br /> 3. <br /> DEC 2 2 2613 <br /> 4. <br /> HFAITW nI713ARTAA'7K'T <br /> 14,Spacial Handling Instruclions and A diknal Information <br /> HANDLERS TO BE TPA!NF-0. . 510 r=r{� t <br /> 'ER" CONTRACTOR: RAMOS Ef11AR0NMENrrAL SERIAC ES <br /> 15. QEtiERATOR'SIOPFEROR'S CFATIFICATION:1 hereby declaro that Ow contents lithIS coneignmant are fully and ac uralelydescrbed above by tha proper shipping na'K aril are dassiliod,padagad, <br /> marked end labeled/placarded,and era In aN'respects in proper condition for(ranip 0 acoarding to appilcablo latearalianaland national govornmontal regulations.I(export shipntont and I am rho primary <br /> Exporter,l conf(y ihstlhe eonlsnts of This consignment conform to the[arms of tiro a tao8ed EPAAcknoxiedgm:nt of Consent, <br /> I cad{ly That iho wnslm nti rim zn6on atalomwit idenfiped to Qt)CFR 2G27,7(a)(li l am a largo quonlity gonerator)or(b)fill am a small quantity generator)is true. <br /> Generauva/Ogeroes P011lecyped Name Sigrt 101C1191 Day Year <br /> —t 1 .tnta aUonaLS(tpma Is <br /> Impad to U.S. ElEspam from U.S. Part of enlrylexik <br /> Transpurior signature((ar expods only): Date leaving U.S,: <br /> 17.Tronsportar Aci:nardedgment of Receipt of Maforials <br /> Ttaasportor 1 PrfntadrPyped Name S• tare , Lie Day Year <br /> O <br /> Trsns a{ar2 n:dlrypedNamsa1v �' Signctum Atanlh Qa•/ Ydar <br /> 4 �3 <br /> 1e.Dlecrepancy <br /> 18a,Discrepancy Indlcalfon Space Qdanity ❑Typ ❑Rasiduo ❑Parltal Rc sclion <br /> J ❑FuIIRoection <br /> Mo!fest Reference Number, <br /> 18b,Altemate Facility(or Generator) U.S.EPA ID Number <br /> Cy <br /> w Facflitys Phone: <br /> tu180.Signature olAtternate Facility(or Generator) Month Day Yoar <br /> •d <br /> Z <br /> ig,Hazardaus Waste/Report/Management Method trades(.e„cedes forhazardous wast)treatment,disposal,end rocycling systems) <br /> 3, 4. <br /> 28.Dastymalod Fac illy O1•ner or Oparafor.Coni6caiion e!recoipt olhazardous materials.altered by Ilia manifest except as noted in item 18a <br /> Prints d Name SI f re 1;46nUt Ory Year <br /> EPA Fami8700-22(Rev.3.05) Previous editions are absotote. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />