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<br /> ® a(5laaaar .00 for type, (Form eel no r Uro on allta 12•p(Ich fAr, Form
<br /> ., . ) lypawrl ) Approved, OMB Na, 20500039
<br /> 41 �% = yUNIFORM HAZARD S 1 , nemlor tD Number 2, Pa !ta
<br /> , Errrerocnry Response Phone 4. Manitrast Trucking umber
<br /> jq: WAS7ElvIANIFI cR t� p� 2Qlq 6 ( 877 ) 577, 2w% 'ew 3 00 DAT
<br /> 5, OenemWu Name o Malling dress 04mrstor'9 She Address (If different Dian mailing addrees)
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<br /> Count Ciu 9i .� 3B1) 8 > Cous9try CiO hVd '
<br /> L7` WAratorePhone! � [CG 'an CA BHA' OB9 ) 4bE -4313 SYUckzcn CA 95204 ( 2i RAGIi - 1313
<br /> 0. Tmrrsponer 1 Com~ U,S, EPA ID Number
<br /> its: ver, �ury r^ v.iron.menta ! oof California , LP 0fa !?CrtlEW: o8 .L
<br /> 7, 7raneportsr 2 Company Name U$, EPA ID Number
<br /> 9. Designated Fed Hy Name end Silo A d" U.$, EPA ID Number
<br /> t: VIR(REWTAL 5ERi3Tr�tS
<br /> UOS5 i JETE ROM ROW
<br /> Fed➢ Phone: R30VCFighting
<br /> U 't3Q OY)) %fl B § 742 19151 5.l •999 i:Ada �380S£11s �t� �
<br /> 90, Ob, U,S, DOT Dowipbon (Indumng Proper SWPOIn9 Name, Nezard Clans, ID Number, 10. ODntglnOra 11 , Tptal 12, Unit 13. Waste Codec
<br /> Nit PedtNp Group (11 any)) No, Type Quenrity WLNol,
<br /> 1 ' 09FIFIACR91 KIARA013S URSTE , LlN111 ( USED ;ill. ) 246L
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<br /> 16- GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby do*m that the contants of this conal➢nment am fully and aowmtWy dostrlbod above by the proper 0l" name, and are cI&sslned, packaged,
<br /> marked and Isbelodlplacarded, and are In as respects In proper oDnd kn for transport bocording to appikabla International and national governmental reg4knoM 11 oxport ahipmani and I am the Primary
<br /> Exporter, I cortiy that the contests of Ws conelgnnu nt conform to the (emhe of the altndad EPAAdarowledgmenr of Consent {
<br /> I oordy that the waste minimi don slatement IdonOFW in 40 CFR 26227(a) (If I am a large quantify generator) or (b) (If I am a oma➢ quantity generator) Is true,
<br /> n elOderor's Pdn Ntano y e Month Day Ygar
<br /> ' ,' Intemaaono 6tirprrhente
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<br /> y` gF1 Import to U.S, ❑ EYgton from U.S. Pon o( OF
<br /> 4 a?ren➢pormrslgnatum (forww* onl :
<br /> 11 Date leavlrq S,;
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<br /> �173mI ai+ W A_d_OMO(lgnwnt of R000lpt of Matariele
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<br /> Tiantpormr2 HntedfTyped Noma svrwluro Monlh Dey Yea l'
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<br /> <I , ,t rq .v , f�blsi7epthncy
<br /> EMISSION
<br /> r Dk%t*aocylndkatlorl SDaco Quantity ❑ Type ❑ Reslduo L ) Partial Rejection U Full Ref eaten '
<br /> ' $1 : .
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<br /> Manffmt Referenco Number.
<br /> 39b to
<br /> Faculty (or Ger9rator) U,S, EPA ID Number
<br /> Cedilye phew
<br /> "lures Alternats ecillty (or namto0 Month Pay Year
<br /> 19. Flatardous iNaate Report Manogornent Memo Codes (i.e., codes for ho?ardouawaeto treatment, dloposel, end recycling syetetrpr) N
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<br /> In Item 16e
<br /> 20, Deslgnatod Facl➢ty OwnarorOperalor. Certincallon of rocei t of hamrdoue maWWa covmr d by One rrwWOt except as nOM
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<br /> EPA Form 87002 (Rev 305) Prevlous edlOens are obaolel®, DESIGNA D FACIE. TO E TINATION STATE (IFR GUIRED) ''
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<br /> Received Time Dec , 6 , 2018 11 : 53AM No , 4444 �''
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