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+ro <br /> n <br /> Please print or type.(FOAn.est red for use QD elite(12. 1:1,)typew er.) Form Approved.QMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator N r2.Page 1 of 3.Emagenry Respome Phone a g Number <br /> WASTE MANIFEST (; A 1, 0 f) 0 2 .8 0 7 Fi E4 1 800-424-93M m6ninciqJJ K <br /> 5.Generatofs Name and Maling Address Atl:Sharon Mulls Generators SbAddaW(0different than mailing <br /> Safawat Inc. SMeway FUN 021W <br /> 5418 Storlerldipe Mall Road:Arun:Sharon PlouRe 43425 N Pecilk Ave. <br /> Pleesaldon,CA 94WS Stockton CA 95207 <br /> Generator's Phare' - <br /> fi.Transporter 1 Co, ams U,S.EPA ID Number <br /> Envir"rdal Logistics. Inc. C A R 0 0 0 2 1 7 5 1 3 <br /> 7.Transporter 2 Company Name . .EPA ID Number <br /> 8.Designated Fadiiy Name end Site Address U.S.EPA ID Number <br /> F1aar Rai Servkes,Inc. <br /> 180 W.Monts Awrsre <br /> BbOmIngloa CA 92316 <br /> F;dJg sPhone: <br /> ga 9b.U.S.DOT Descripfion"udkg Proper Shipping Name,Hared Gass,ID Number, 10.Cclacal rs 11.Total 12.Ura 13 Waste Curbs <br /> HM and PacBig Graup(If any)) M. Type Quantity Wt./Viol. <br /> of 1UM3175.Solids conbk ng aammabM kquld,n.Qs.1"61disse0.4.1. <br /> 4a x FI <br /> z z. <br /> co <br /> VICES'RIALTOFA peerml INA, lit � <br /> lA ., ti (cry-1 �-..,•yam <br /> 4 <br /> 14.Special Handling Instructions and Additional Infortnada 1 NS)GasyDkasal 1Mle43.KOs,NO ZNs.Fuel Breakaways- 11091417 ERG/133 <br /> R"I75OWN <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accuratey,described above by the proper shipping name,am are classified,peckaged, <br /> marked and Iabeleclplacarded,and ere in all respects In proper condition for transport according to applicable international and national governmental regulations.N wipurt shipmentaM I am the Primary <br /> Exporter,I carry that the contents of this consignment conform to he terms of the attached EPAAcknowledgment of Consent <br /> I car iy that the waste mindn'varon statement certified In 40 CFR 28217(a)It l am a large quantity generator)a(b)INIa quedily,generebr)Is true. <br /> Generator'sl0Rerora PrinledlTyped Name Signature Day Yea <br /> .� <br /> 16.Ireemational SNpmeMs ❑throw to U.S. ❑Exportbom US. Pad ofentylaidt <br /> r <br /> z Transporter sig arture(for efports only): Date leaving U.S.: <br /> w 17.TranuporterAdmowbdgment of Receipt of Materials <br /> wTra Pdn typed ryame yi Q Sg i/ „/�i Man .Year, <br /> < Thump orte dratedinyped Name 'gnatura Month Day Year <br /> C <br /> r <br /> 4. 18.Decrep inq <br /> 18a.Discrepancy Indicallon Space ❑ QuaMdy ❑Type ❑Residue ❑Peru Rejadi n ❑Full Ro don <br /> Mant esi Rearaxe Number. <br /> 18b.Aftemate Fadlsy,(or Generator) U.S.EPA ID Number <br /> 7 <br /> U <br /> LL Faciliys Phone: <br /> W 8c Signature otNtemffie Facility a Gendedil Month Day .Year <br /> zZ <br /> H19.Hazardous Waste Report Management Method Codes(IA.,codes for hazardous waste Instrument,disposal,and recycling systems) <br /> 1. 2. 3. 4 <br /> 20.Designated Facility Owneror2M.Cedricallanofraosiptalhazard s nbterbls covered by sire manifest t as ndtl n m5T A <br /> 1 dnt yp I q nmu rr s oJoey ser <br /> EPA Form8700.22(Rev.3-05) Previous cons re so DESIGNATED-FACILITY TO GENERATOR <br />