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1650252 <br />Palen nme, nr s— IP—dna W¢ea nn Wiln f17.nidsl Iv WrIleif QQQ""" Form APWm'ad. OMR No. 2050-0039 <br />EPA Form 8700.22(Rby. 3-05) Previous saloons are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORMNAZAROOU9 tGWammr lD Numtar <br />2.Psgp 1,al <br />3. Emergency Raepona¢ Plan¢ <br />,�,�=1 <br />4, Manitost Trac n Number <br />DAT <br />WASTE MANIFEST �n::�o�, �= z, t; <br />z13z» >7,7 <br />0000815 7 <br />G.OWamYKSNana entl MalNnyAdkosa . GenarplpfaSiWA0Neru 0161fe eel amn modulo awroos) <br />e�ti;N cc &rr PL11H W s0LTD (AHE Misle_� UNRL WILLoe'•.P . )�, <br />Ir.1 nM39 el 41l <br />f.,c—uTSV P,H Juno rn. 55117.12S8im-na <br />Gerumatte'6 Phone <br />G. Tmnspivler I Company Name _ us EPA ID Number <br />.�>t En,ri;fll't"'1T1zt T1ana3Clerlt of California, LP CflRO{it321Gb1i <br />1, T,a. 7Mtor2 Company Nmne U.S. EPA ID Number <br />;, 41RGNNENTAL 5E YICES £Ei Q 25'� 433 <br />NI),,vgm,F4 Er. j.ty fl at ma and SA a Addles U.S. EPA ID Number <br />,.. [ CDi09y k0 fdss2 <br />y is, 11 tlile9 S_'ot ieatty F.O. tog 576' <br />Feu aRwne:2CAt-IY,.P P3ii&3 IMI 553-2I0 ,=`jVT336!ti:Clflf1(3 <br />So... <br />%US. DOTDesaoton Ondodaw PmpW SNppmg Name, Hm d Gass, 10 Numee-. <br />10.Owtaft ns <br />11. Total <br />17. UnA <br />17. WawCoeos <br />No. <br />Type <br />HM <br />wid.Peckho Oroup.(M any)) <br />Ouarny <br />Wtm <br />171 <br />z <br />2 .. ... <br />LU <br />w <br />3. <br />4. <br />16.SW 1 an and tldjraVml mlamaaM /}� <br />a VHIIH;St:60 ASH W SQIL615r• I -70753A 1IN t.� <br />u - EMT M <br />I5. 'GENERATORS/01TEROR'S CERTIFICATION: I hereby doclare thatthe commnts N Oft cWuigimmnt are fully and amara" destteml abovebythe propershippino namA ard saw Classified, packaged <br />mtaryad antl wWlad'plzcordm, slid Ne m ad reapers Npop¢icorodANk iW Uarmlatt aaomug b appilrade IntemmlbnWand naaorml Aovemmenul regulations. Ileapat sh'gaVmntarrd I am tlia Primary :, <br />EapWbwlcertilyfall0m=m iWo.fM;sansi7imnform WIbetermsoffmanadadtPAArhnowbdemmnlNCWsmm. <br />I wr81y that Na waslu mInfmuotim statement Identified N 40 CFR 28227(a) 011 am a Mrgo gnanlily generaw) W () (if l y gawNly gonemmar) a We. <br />6a2falablsWwoesfthadrfypod Nom�o- lashes MWah Year <br />" <br />J <br />16.VAenmaamShipment; ❑ImportmUS' .. ❑Eapodfrom us,: Pan ofedymdn � <br />Traorer oralumflorexports only) r'.._ _. _... .. - •` Dew baling U.B.: -_— .. .. .. <br />mp <br />a <br />ti,TmWnle+Admrn'ladpranlNNrceiplNMa:enila <br />Done mWarryped N' <br />51gn Manor Day Year <br />a <br />ransewar2 Nano S1941buff Month Day 4dr <br />-a /S <br />¢ <br />0 5 is <br />T18.OIsWepancy <br />tAa.Dieaepancy Wcallon Space ❑ Quantity ❑Type ❑Rosaw ❑ portml Rejection ❑Full Rejection <br />I <br />Manifest Reference Number. <br />18h. Alternate Fadaty W 0wo ator) LLS. EPA ID Number <br />J <br />U <br />u�. <br />Fadeye Phone: <br />9 <br />Y <br />1 8c. Signature of Aftimene Faclity (m enamor <br />Irwin ay year <br />y19, <br />I18Y]IdOVb, Wdala Report Man9gWneal{.1@IIICII DCdBe p.C., codes for haZa(dW9 W84ta llealmOnl, dOpaeN, and lacytlng ay9101n5) <br />1. <br />2, 7. <br />4. <br />20, Designated FaClllly Owner or Operetta: Cerdfcetloa Or Wc*lofhaa udour, materials covered by the manliest oacept ae noted In nem pea <br />1 <br />P*W1 µhue, Mh Day Yew <br />S a! 13 <br />EPA Form 8700.22(Rby. 3-05) Previous saloons are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />