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2018-02-01 10:56 Safeway 2707 2094728604 >> 2094683433 P 4/8 <br /> Please print or type.(Fom designed for use an ettle(12-pkh)typewriter) Form AWoved,DMB No.2050-0039 <br /> *m"eas'ID N"mow 2.page I Of 3,EmvWrq kospories,More A.Mantled Tracking NuMbIlf <br /> )0 1, 7;. � & i, -� ..' j; .1 <br /> 'IN'! I 1 11 1 1 1 1 Q 1 R A AS 7 J JK <br /> WASZCM=AWI CSTUS 11 C t., " �' 1, <br /> 5.Generators Name and halvelmIj Address Gursuilor's Site Addiss,(6 different Iran malln Warm) <br /> JI ;,kip I <br /> f< <br /> Generators Phone, 1.4 <br /> 6.Transpolar I Company Nsme U.S.EPA ID Number <br /> 7.Tw5portser 2 Company Nommi <br /> D*rwled Fad"anne and SiteAddrese U.S.EPA ID Number <br /> Facet t'a Phone: <br /> pp. 9b,U.S.DOTDescripborl firglixiinG Proper Shoping Name,Hazard Class,10 Number, L,cordsilpTya, 1I.W 12.UNI 19.ywe codas <br /> HM wdPscWngGrvup(Ifmy)) Quantity VVIAK <br /> 3. <br /> a <br /> 14 .1 Handang InafteliNg aA AddlUoial Infomollon I 1(1 1,ki 1 'A.' !A, r) Vi7riF,:k M 1;r-.V <br /> 15. GENERATORWOFFEROKSGINK"MAY1011:1 hereby dedtre that die contents of this amsIgnment are J14"no accurately described above bythe proper shipping name,oncl we dauftd,paidusted. <br /> markeol and lebeledlplaceded,and are in all respects in pWr comOor,(o(Vanspen flocronang;to appluble ineamawral and nawmad gominnamiles resolaron&If expW shipment and I am Ow Primary <br /> Exporter.I cB*that the carrimts of Iris collsolossal conform W me corms of to attscried EFAAclovolcognitnit of Consent <br /> I Wrply anal tl*waste muramouation statement idanalled in 40 CFR 202.27(a)(If I am a larva Overlay generaWl)or <br /> (b)(KI 9m a annallqwnbty generator)isaur. <br /> Owe tsf0heror's PdnledlryRed Num, Morth Day )(M <br /> Is.International slipmenti <br /> El Export fionn V& PON of anIfYI&I, <br /> Transportariognature(for expores oftly): Dale towirg U.S. <br /> 17.TopospAce Aclonavlodlynnerd of Receipt of Materials <br /> TraraVorter I Pdntedrfyped Now Signal" Wish Day Year <br /> ITrenaportar 2 PARMTYPW Muns SKrffUe Monet <br /> Day Year <br /> 4. 18.Discrepancy <br /> l8s.Dsonapancy Indication Space quantity Ll type EIRm, ❑P.11.1 Rejection LJ Foe Rqxdm <br /> Marl Reference Nurnber. <br /> I so.Alternate Fadfly(or Generator) U.S,EPA ID Numloor <br /> FacI[Ilyre Phone: <br /> les.Signolone of Afternal I'scifily(a Generate) Month Day Year <br /> 19,Hicandous Waste Report Management Method Us$i-,codes for hazardous waste Vestment disposal,and recycling systerns) <br /> 7— 3, 4. <br /> 1 1 - 1 <br /> 120.0991lIftfifed FadRy Owner a Operasor,CoMcatson Of reff-0 of hicumdous mantarials worad by the awaited excerl&a wed in hem fee <br /> IPrIalKlyped NWOI siplaturp MOMM Day G7 <br /> EPA Form 8700-22(Rev.M6) Praybus editions are obsolete. GENERATOR'S INITIAL COPY <br />