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BOYETT WAREHOUZ-1E PAGE 08/13 <br /> 08/15/2013 14:20 2095291"� <br /> a d. <br /> GMerator.mail a WOY W. Ura- Marto re <br /> Form Approved-OMB No.2050-0039 <br /> Please print or type.(Form des! nod for use on elite(12-pitch)typewriter) ;y P.*4on&e phone 14,Manliest Tricking Number <br /> des! <br /> TUN 'p:'ZARDOU5 ,..OtmaratorlDNumbcr <br /> kRDOU-` 35 JJK <br /> UN'F'RM 0086428 <br /> WASTE MANIFEST I-V1114 ;7$7 <br /> Carieratof�SZoAddress,'n d"Ie7ent 2111ailingaddres;) <br /> s Name and Mailing Add <br /> Z <br /> li37 V- 40715-a-:5W <br /> Generators Phone: U.S.E <br /> 6,Transporter I Company Name <br /> U.S.EPA 11)Numb& <br /> 7.Tranportor 2 COMPOY Name - AUG 21 2013 <br /> U.S.EPA ID Number <br /> 8.Oplginaled Facjjjty Name an'dSbAddr�Sg ENTAL <br /> 688D sm,"Ch Ave-• HEALTH DEPARTMENT <br /> Ca.045,50 <br /> Facilit I Is Phone: 51 Ci-?Q5- 10.0ontainers 11.TQ�q 1 12.Unit 13.Waste Codes <br /> 9b,u.s.DOT (including Proper Shipping Name,.H=rd Class,ID Number, <br /> 9a. F—No. =Type Quantify <br /> HIM and Packing Group(if any)) <br /> � <br /> 0 <br /> 3. r ------ <br /> 4.Special Handling instructions and Additional Intormaticri <br /> lie <br /> 15. GkNERATOK$jor FEROWS CERTIRGATIOW I hefeby declare thatthe contents of this contignment are fully and accurately described above by the proper shipping name,and are(lass'lled'packaged, <br /> marked and labeled/plecarded,and am In all resp". ..in proper condition for transport according to jppuoa-ble intBatetionalaid national governmenttil regulaijorr..ff export sinIpment and I am the Primary <br /> nmBrTtocnfbrr,t to the terms of N-attached EPAAcknowiedgment of Cent.OM <br /> Exporter.I certify that the contents of this consig <br /> I Oqrbfy thot the wage minimization statement idontiflod in 413 CFR 262.27(a)(f Ism e!crQ@ quantity� gr`Wx)Or(h)(if'am a small quantity rggrtgralor)Istrue w.nvi wly Year <br /> ts,.-P-Tura <br /> Generator�/Offaroes Pn'nted/T-Ded Name <br /> 'b <br /> 16.ln�tcrnaional 5r,076rlts F�Import to U.S. L fror,U-S- Port,of entrylaxit: <br /> Data leaving U.S.; <br /> Transporter signature(for.&Npoda only): <br /> w .17.Tran5portorAcknowledgmerit of Receipt of Materials to Day Year <br /> tped� <br /> Name No- <br /> 0 Yew <br /> EL Day <br /> U) <br /> m TrWMporter 2 pnntM/lypeO Name <br /> 8,DIscreo—Y <br /> 18a.Discrepancy Indic*Wn SW-8 ❑ Qtintity El Twe ❑Residue ❑Partial Rejection El Full Rlied- <br /> Nlanilrz�st Reference Nlumber. 1. <br /> . . U.S.EPA 10 Number <br /> j8t>.AItemata Facility(or Generator) <br /> wi*s Phone: <br /> UO I Bc.Signature of Alternate Facility(or Generator) <br /> s().a.,codes for hazardous was!O halFnent disposal-and racycling SW&RIS) <br /> .$K ard6ktSNsste Report Managamt Method Code 4. <br /> ma mitis&VC.-e d by ttle rrr�-MqRst syrApt;�s Ojed In Itern Sa <br /> 20.Designated Facility el or 0p;ritar.certification of racalpt of hazardous R9onth Day ear <br /> $ignature <br /> Printe0ypod Name 10�"10.3 0- <br /> jESGNAT <br /> - <br /> ILITY TO GENERATOrl <br /> EPA Fann8700-22(Rev,3-05) Previous aditiofm are obsolete. <br />