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Jun' 02 2015 9:03AM HP FaxLadds Marina 2094779585 <br />144 1 P <br />Plea" print Of "0. (FOrm clawnad for use on elft (12 -itch ) "ewn1w.) <br />UNIFORM HAZARDOUS ,-wqrM1DKUMhw F2P-v—3E <br />I R7 <br />WASTE MANIFEST ret. 000?�11 I irsAt .ti <br />5. Generatolt Name and Mdwv <br />LM60% MArl"a <br />4339 Backlay Covo way <br />Stochkim <br />cvneraws " P>.4 1 .7 <br />5. TranspbrIaj I Compgy "* <br />rw" <br />7. TranWorlar2 ComRFN—wm <br />page 2 <br />- 17 se <br />RE <br />, (N WWI —ba n <br />'offs AAp�+ed.OAIB:Npk�4-0QZl <br />9 Rumbsr <br />0407 -SKV.. <br />-NVIRONMENTAL <br />4. <br />HNMV Mmindions and Add Mfwrmbon <br />GMEMAAWSPOFFERORS CERTIFICATION: I hemby declare VIV the contents of this consignment are My and accum" dqs�06jd a by <br />malted a6il loWeNplacarded, and we in all reapecta in M"t ccrld*n for transport ac ing 10 apo bq i land *W above N PropersftiPa Awe�.srd are rises tied, pacIQ94, <br />Omd ice n*rabw no gmwmOrtal mlimMons. Ifexport shipmentand I am the p6my <br />oww tmj-* "M rninftlaft statement W in 40 CFR 262.27(s) CO I am a *90 quantity prervtowl or (b) (jfl v9small quarrilty "naloodlftw. <br />7 59W" <br />16. tntemlionaUgh-1pnonft <br />Transporter signatory (tor exports oriy)! Import to U.S. Lj Export from U.S. Part Of w"eAt <br />17. Tfan"Adr-0*0dVKh1 of %w1pt of M19*01i Dale leavrq U.S.: <br />TFNnted7Typed,!W9 <br />Mons Day <br />Lo <br />-miWoor 2 FfintedlTyped Name VA <br />Month Day, 1 <br />18. Discrepancy <br />18a- Discrepancy Indicallon Space Quantity Typa ❑ Residue❑Partial P -jack. El FA R*,b. <br />LA; FMS Phone: <br />78c. Spilin ofk1ernab Faality (or G;;;Er) <br />moo <br />1 P. Hazardous W" Report M&Wamwt Method Codes 0,&, codes lot hazardous waste "glnwt, deposal, and "rig 6yd-S) <br />23. DwignkW Fac* Owner or Opereiv. Csrffiu' Vw of recelpt of hazardous rnalsr4s covered by the inamfast except as nclaci-in—item 18a <br />rfiedlT <br />Sipnahtre <br />EPA F <br />editbns are obsolete. <br />GENERA 00F <br />'-I 4'Q4 tAR AK SAN JOSE– },.Ie r <br />U.S. EPA ID Number <br />4111fj- 44 1, -PA, ,;D <br />FadgtYs Phon c <br />ge, <br />9b. U.S. DOT Deschplon (IndLdng Proper Stripping Name, Hazard(;,3w. 11) blunter, <br />rlars <br />I <br />. HM <br />and Packing Group (if any)! <br />11. TOW <br />12. LIM <br />13. Vbsft Coclob <br />1 <br />1 <br />No. <br />IMM.. <br />P - &A i -0, <br />6 11 1 <br />"*, <br />tat <br />I <br />-NVIRONMENTAL <br />4. <br />HNMV Mmindions and Add Mfwrmbon <br />GMEMAAWSPOFFERORS CERTIFICATION: I hemby declare VIV the contents of this consignment are My and accum" dqs�06jd a by <br />malted a6il loWeNplacarded, and we in all reapecta in M"t ccrld*n for transport ac ing 10 apo bq i land *W above N PropersftiPa Awe�.srd are rises tied, pacIQ94, <br />Omd ice n*rabw no gmwmOrtal mlimMons. Ifexport shipmentand I am the p6my <br />oww tmj-* "M rninftlaft statement W in 40 CFR 262.27(s) CO I am a *90 quantity prervtowl or (b) (jfl v9small quarrilty "naloodlftw. <br />7 59W" <br />16. tntemlionaUgh-1pnonft <br />Transporter signatory (tor exports oriy)! Import to U.S. Lj Export from U.S. Part Of w"eAt <br />17. Tfan"Adr-0*0dVKh1 of %w1pt of M19*01i Dale leavrq U.S.: <br />TFNnted7Typed,!W9 <br />Mons Day <br />Lo <br />-miWoor 2 FfintedlTyped Name VA <br />Month Day, 1 <br />18. Discrepancy <br />18a- Discrepancy Indicallon Space Quantity Typa ❑ Residue❑Partial P -jack. El FA R*,b. <br />LA; FMS Phone: <br />78c. Spilin ofk1ernab Faality (or G;;;Er) <br />moo <br />1 P. Hazardous W" Report M&Wamwt Method Codes 0,&, codes lot hazardous waste "glnwt, deposal, and "rig 6yd-S) <br />23. DwignkW Fac* Owner or Opereiv. Csrffiu' Vw of recelpt of hazardous rnalsr4s covered by the inamfast except as nclaci-in—item 18a <br />rfiedlT <br />Sipnahtre <br />EPA F <br />editbns are obsolete. <br />GENERA 00F <br />