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1w2 - 06 - 1811 . 58AM ; # 2 / 2 <br /> Aq <br /> old AN <br /> "''' ''' ff �J �(. —.ala ((� 23015 ( 1 ) .> <br /> Form APPr d. OMB No, 2050-0030 <br /> i`. )y1B09�,r,,r�ltar type. (Form est n r use on elite 12 IPh) typewriter. <br /> ra C1NlFORM HA7s1RD S 1 • tutor ID Numbor 2. Pago t of 3, Emergency Responao Phone 4, Mand st Trooking Numbor /� <br /> '• .' ',; WASTEMANIF CA1. 0 � 0 .tt3 436 �L ( 87711 577 -2v% E% G 00DAT <br /> Genwrobofa Name Halling dress Gonemiofs WAddreea (if ddferent than malling address) <br /> st d-tion Gal ,',40n • y Glob Stockton golf Courttry C1art; <br /> 39bD U Coot . C10 . 31 yd 39 (18 19 COWirrr Clot) Rom <br /> GenereI 9P we SiOC On CA 95204 i, 2D9 ] C61 -4313 SiOckrtn 1;A 5320 ( 2US ) � 6fi- 9313 <br /> 8. Tmnaporter 1 Com U.S. EPA ID Number <br /> r 21st+C Centt. rN i': :, VjrontneriAN Man -alq tont Of California , LP icnok00032-L1761 ? dd <br /> 7, 7ranaponar2 Company Name U. . EPA ID Number <br /> 0. Dealgneted FedI ; Narne and Slle Addrosa WS, EPA ID Numbor <br /> GEN.N&)i EgURO)" NTAl do"T , 1 LC H4 He BVIR()NI'tk`Nd ScR9If,•c5 <br /> i.cd :5 � 4iTl= 20M 80114 <br /> Facet sPhone: RF!` NO ;ORDOYN 0 95742 19i5 ) 3514-0980 CAN 808b34• 1a ' • <br /> gat Ab. U.S, DOT DoWiiption Qnduding Proper Shipping Name, Ha d Gaal, ID hkrmber, 10, Contoinera All 12. Unit 1 a. Waste codes <br /> HM and Packkq Group ((I any)) No, Typo Ouon6ly WtNol. <br /> a 10 1}Oi(-f1CRR MIRRIDUS OASl'L- , L.10011 ( USED 61L ) t 221 <br /> 2. <br /> 1 <br /> 3. <br /> :i <br /> i <br /> 4. k ! <br /> 3 <br /> rte"X16 4 k ' <br /> 14. 6paclal Handling Inaeuollons anaAgd clonal information <br /> C i. ) 7 fi WI NNIIN - R fir'' UIL I(: 02L QV V/R0i�rMEIV NAN, �r <br /> HEALTH <br /> 16, GENERATOR SfOFFEROR'S CERTIFICATION; I hereby declare that IN contents of thla consignment are futy and accurolely doscribed above by Ina Proper shipptnp name, orH ore daserfied, psrJraged, <br /> merited and labeladplawdod, and are In an respects hr propel condition for transport according to appiloobte Internatlonat and notional govemrnenta! regulation, If export ahlpment and I am the Prlmary r <br /> Exporter, I certify Nat the contlstts of thlo omilfgnment conform to the tarns of the attached CRAA.cknowtedgmam of Cowl l <br /> IN I cedlry that the waste minimi bon statement Identlded in 40 CFR 262.27(x) (if I am a largo quantity Sona alar) or (b) CII am a amcil quantity gonorato41s we, <br /> t; •dd <br /> efOtferoee Pr1n Name Signa Month DayAm <br /> Y r <br /> ll <br /> 11 <br /> , NA <br /> ez <br /> le, in <br /> Shipments t� <br /> P f 1 I : <br /> l i to U.S. ❑ fromU.S. ort o entry ex i <br /> Aron Naw ebneture (for exyorm only); Dote Ieaving <br /> 47: TriijragpRerRcvwwladWMAtofRecalptofMall <br /> NINN, 11 <br /> I to* Transporler'1 PrintedITyped mo 8lgnsture Month Day Year <br /> 5 <br /> ;� � .Transporter PrintmUiyped Normo Signature Monet Doy Yay , <br /> T ' : ' <br /> PAN ssY ' fDidatifiaruy ''' <br /> T <br /> ;. : >3Add <br /> 'D.li diepency Indication 5ptuo Duentlry © Typo ❑ Raakluo ❑ Ponlsl Rc(ectlat ❑ Full Rejection <br /> t <br /> 0140 All <br /> M"feai Reference Numbor, 1; <br /> 19b:Al�mate Fecillry (or0enerstod U.S. EPA ID Number <br /> F>,Wkya'Phow <br /> ImlalgFialureolAtIternAlo ecillry (or erator) Mondt 715Ay Year <br /> yy <br /> Almost <br /> N' <br /> 19. Hazardous WOW Repoli Management Method Codes Q.a„ codes for hazardous waste veatriwil dispoRal, and recycling system) sl <br /> top 1 7- 77F <br /> 3. 4 , iR <br /> i <br /> Ih ' <br /> G <br /> 20, D"Iti tad Fodlity omteror Operator: Ceraileetlon of reoolpt of hazardous rnsledals covered by the manifest except as Wed in Item 18e l <br /> PMtedf"Tw3al SlgnDwm Month Day yaw J <br /> EPA Fomt 8700• (Rev. 3.05) Previous editlons are obsolete. DESIGNAT D FACILIT TO In TINATION STATE (IFR GUIRED) <br /> Received Time Dec . 6 . 2018 11 . 54AM No - 4446 ip <br />