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2018-02-01 10:56 Safeway 2707 2094728604 >> 2094683433 P 6/8 <br /> Plimeprint or type.(Fqrrn dealgfled for use on elite <br /> (11-Otch)M)Wter.) Form Approved.OMS No.2060-OM <br /> UNIFORM HAZARDOUS 1.'�`amralor[a tw— 2.Peg�c i ut 3.Emeni;emy ReWee Phone 14,Moaffol Tricking Number <br /> d;.WASTE MANIFEST � ! o k.) c, 1. <br /> 1 019465029 JJK <br /> 5.cWmaws Warm and MaHingnmP051 Gerembra 814,Aftoaa Of diffivent than.maling address) <br /> W-z,!"V41,fi R . rk1of P., fN <br /> .SAW <br /> Genemoh <br /> I-Traw"flCommyFuT. U.S.EPA ID NoWt <br /> Lkl�a!Apn.dFii. c i; 1f 0 c! c .... I ? $ I . <br /> 7.Transporler 2 Company Name U.S.EPA ID Number <br /> 8.Du4naled Fadity Name and Site Address U-S.EPAIDNmbor <br /> 1.4mrstal 1hr. <br /> LV <br /> FOGIV$Ptm Ai4; 1.r44j to i. 3 'r <br /> so. Ob.U,$,DOT Dewpum(induding Proper Sh"Name,1101(d Oars,10 Number, 10 Conital is 11.11101 12 Unk <br /> HM and Padang Cirgap(yang)) Nb. Type Own* WvAdl 13.Vfth Codes <br /> piallitrotka Pta6l"i %o Y- ui, t <br /> oi <br /> 4. <br /> 14.Spedad Handling lnsbudana and Mdolord InjonneWn 1 1,r,i A bsAw ID&r 11, D III;I t t t, &�,Vj 0 1 7;,J, E P Gt-1 *Y".1 I'M,'".4elq <br /> I& GENERKMIVSIOFFEr(Ok'ACM"PICATION;I ft"dedare thiddhe comannselthism"gin"m we l0lyanda"tavl*dlawribcdabove bydrepropershopngnams,and wokaTied,packaged, <br /> Marked and labeleplacuded,and are in all rea,"In proper condition(a unmaw acmding to&Wuble inlerreenmal aml national goners mental regulation.11"W ghipment and I am to Primary <br /> Exporter,I ce*mt Ift amerits of this onnuipmBrat conform In the Nora of the a%athad EPAAcimmWedgment DT Care4mit. <br /> I car*Met the mVe mirml2allan 110ernart Identified in 40 CFR 262.27(a)(if I am a lome <br /> quartRygemalo)or(e)(01 am a wag quantitygenerator)istrus. <br /> GanaralorWilanor's Kin ayined Name SiIiffilurt Month Day Year <br /> 16.Inlemallonal Sin monis <br /> 1— llimpadtou.s. ❑Found from U.S, P.1 of entrylev <br /> Transporter sIgmtwe(for cxpurtsonry): Dab leaving U.S.: <br /> 17.Trarspoler AalmovAedgmad of Raceim of Mateftis <br /> O %raporlor I FmnWy*New Signante <br /> Month Day yftr <br /> Thenworler2PrinledlTypedName Signalure Month Day ar <br /> 18.Dweipancy <br /> 18s,Dkowency Indication Space F quanfiry Elype 0 R11A, Elprd.m*hm ❑F.B R.Jecb. <br /> MmndeviRplenmceNumber <br /> 16b,Allmotc Fpcility(M GWW`dtWj U.S.EPA ID Kunnber <br /> FaciltyB Phone <br /> 2 18u.Signehmt ofAlWnale Fadity(orGenera" Month Day year <br /> A 0 9.Hm*n Waste ROM Management Molmd Codes(ie,md�,for haumdous wave Ireatment.di,nmt,and re*11m;eysleme) <br /> l 1 <br /> 20-0814SM18d Fz0o00"MOParaft CWWMW Nmwdp101ha<artleucmatedalx swaaBd by1hemanutemtomaownctodin hem llla� <br /> ptntedilypea Name Signahm, Month y <br /> EPA Form 8700-22(Rev.3.05) Previous acillons are ObSolaile. GENERATOR'S INITIAL COPY <br />