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13-ifrhl hirwurrttd I <br />I Form Approved. OMB No. 2050-0039 <br />Please <br />print or type. ti-orm.amilylitou -J- - Manifest Tracking Number <br />1. Generator 10 Nunjo 2, Page 1 of 3. Emergency Response Phone 171- <br />("q' A24-93GO <br />UNIFORM HAMRdbus 7 00554711314 J J K <br />7T�] <br />WASTE MANIFEST <br />Generator's Site nailing address) <br />5. Generatq 7 <br />q 7 �Ci(fow <br />{5�21 CkARIER WAY CA <br />T f X�'K7 ON <br />-AC-PAKENTO <br />Q <br />4r4oes Phone: U.S. EPA 10 Number <br />6. Transporter —1C--P-Y Name 1? 7 7 0 3 <br />C A 1) 0 <br />AF&V.y f7.o4ViPf--;f-1#,f NTAL i3 -f -PACES <br />U.S. EPA ID Number <br />7. Transporter 2 Company Name <br />U.S. EPA ID Number <br />8. Designated Dqmy�nme and Site Address <br />i IEWNW; KEY ff- <br />-44'rH ALAW-CIA STREET <br />SWW -,,A r, A T 0 3 0 0 1 3 3 5 2 <br />�Iifwcw <br />q? <br />(3Tr, Ift <br />Facifi <br />i Phone: <br />'i Phone <br />9b, U.S. DOT Description ('including Proper Shipping Name, Heard Ciass, 10 Numcer, <br />Description <br />.1 Total <br />QuailWy <br />12 [Jn,t <br />13. Waste Codes <br />ga' <br />Te <br />i <br />rand� Packing (if -Y)) <br />No <br />HM <br />Ly <br />1. <br />WASTE UW0 OLY <br />tlrf WATET) <br />0 <br />2 <br />2 <br />THIS WASTE STREAM HAS BEEN QUALIFIED <br />EOR REGICLINGIT?EA-IMENTATTHE <br />3. DeMENNO/KERDOON FACILITY IN COMPTON, <br />T ECESSAR' <br />HAS HE N <br />CALIFORNIA. THIS FACILITY HAS <br />A I rA4. 'EAM AS <br />4. PERM—, j. . <br />QUALIAED, OUR EPA NUMBER IS CAT080013352 <br />W lnfofmaUon <br />-'L Y LAIER E r,; -p NAL PRfVECTIVE Eq <br />1 P <br />E43 <br />FAt2 f' <br />pb 41 Aa�,6,1&5�Ve <br />Z40i <br />i <br />GENERAMR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are claiisifledl. pa mar <br />regulations. if export shipment and I am the Primary <br />15. net andnational governmental <br />marked and!abetediplacarded, and are in at respects in proper condition for transport according to applicable internatio <br />conform to the terms of the attached EPA Acknowledgment of COnsfny <br />Exporter, I certify that the contents of this consignment <br />I certify that the waste minimization statement identified in 40 GFR 262.27(a) (if I am a large quantity generator) or (b (if 11 1 qqa small quantity generator) is true. Month Day Year <br />GeneSPI <br />q1'0'1`s'!C" IN'!1or's PrintediiTyped frame <br />–leAnternational Shipments Elbmvrmus. <br />H import to U.S. Port of antry/exit <br />P– <br />9 <br />Date leaving U.S.: <br />Transporter signature (for exports only): <br />W <br />wSignature <br />w. TrensporterAcknowledgment of Receipt of Materials Month Day year <br />t2 <br />Iramptyie, i Printed/Typed Name LZ21 e�xl <br />0 <br />IL <br />N/re/ y Year <br />Transporter 2 Pdrited(Typed ame Signature <br />V) <br />18. Disc p— <br />iiia. Dscrepancy indication Space ❑ Type❑ Residue ❑ Partai Rejection Full Rejection <br />u—if.d Aofi—v� Number <br />- <br />EPA ID Number <br />18b- Mernate Facility for Generator) <br />Month Day Year <br />LU <br />T8c. Sigtaturs of Alternate i- 3c"ftY !or ��eneFatwi <br />I I <br />1 <br />19. 4az ous Report Mariagemer)tMethod Codes (,.a - fides for i" is waste bre eow—t, 6;sposal, and iecy6N. systesystems)1 <br />ris <br />LU <br />en <br />2. <br />I <br />20. De--ignatad F acidly Ower Of Operator cenificatton of receipt of nazardous m.tenals covered by the manifest except as rated in hern !J18 <br />Month Day year <br />S."riature <br />P,inied(i yped Name <br />FACILITY'S COPY <br />--:PA. Form 8700-212 !Rev. 3•U&,) Hrev,Ous <br />