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RECEIVE <br /> P ease pdnt or type ForrinmInved.OMB No,2050-00;9 <br /> UNIFORM HAZARDOUS 1 C�enerewr ID Nurrtav G <br /> p . gyPhone A u.MJ445636JJK <br /> Number <br /> WAST£MANIFEST CQ89Q09=2 �.� ma�ng <br /> 5 Gaiwabes <br /> Us and MEd tab Site 30D an bt:!hW d i!5 NMA Wwmwe L�it!!lllaorttt�Ne!of�Um 3As 30D ort MW&US WM <br /> PA.Boa[SM/ON WeI17110 a CA 9651 GGrrd Hdbw Rood,TtSGy CA 95376 <br /> Generatda Phone:9254M-1923 Anft Sill PPV <br /> ti Transporter 1 Corrgany Name U.S.EPAiD Number <br /> Clean Harbors ErMronmontai Swvkes Im ""22250 <br /> 7 Transporter 2 Company Name U.S.EPA ID Number <br /> B.fksignated FaaTAy Name and Site Address U.S.EPA ID Number <br /> Dean Harbors VW"VrWM ULC 1737 E.WM 2re VMibllirpton CA W7,14 CAD0444MS <br /> Fadm evPhoma: =405�M998 <br /> ga, W U.S.DOT Desrnpbm(undurbng Pmper Sib img Name,Hazard Clan.I D Number, 10.Combines 11 Tdal 12-Un4 13.;Haste Codes <br /> HM and Padang Group(H any)) No: Hype DiINLNd. <br /> 1 N fl itA islaxardous WW4 Wid(WED Oily DOPWWl 4 DM 1363 P <br /> 222 <br /> LU 2 Non-R�CRA hnardaM wry�d(USED ay DMIND-s x DM M P <br /> 3.Non-ciao►MWIl"waft*W(USED aU Douai 4 aF 230 p <br /> 222 <br /> 4. Non-ftCiiA h=fdo=Wg t+.ft"(USED au Dop=j)4j 2 DF 34 P <br /> 221 <br /> 1 Special Hands s9ln =and <br /> 9== DA=�'° 2 -4M cD�r tl>a u�w. ar.iia r wuza .�ia�D«n� <br /> S-. r,��Rear nuns W 1.XE,Q�on inwoim Sae atta%W for tdritdnW numbers. <br /> LiENERATOR'Sf 3FFEROR'S CERTIFICATION I here tlrat the mrderrb d Ihb conaigrur enc ora Tiny and accurately dr»albed above by"WoW shlppinp rww and ora dassiW parkaped, <br /> marked and lebefedlpiacarded.and are in as mgm:b In proper mrditfan for trenspod 9=rdbg b app mbb inlemati inland naOonal govettrtWU regulations.N export shipment and I em the Primary <br /> Ixponer.I teddy that the omwts d the wmsgn omt conform m the lama of the aWad PAAdwmAW9mem d Consent. <br /> I oertry brat the waste minfmhalion etatemeM Idenetied In 40 CFR 2021T(a)(If I am a large quantity peneralor)or(b)(rl arrr a smrBT rprantny r b hue. <br /> GenerviWeOffemes PrinteCyped Nam Sgnatum Month Day Year <br /> Scott A.GraMm on behalf of u5 mwA Ee z tw. <br /> a 18.Intemahmal Sh ip is <br /> ❑Impart 10 U.S. ❑Export ham U.S. Part d entryler, <br /> E= Trargporter slgnahae(for exurb Dory): Dasa leaving U.S.; <br /> tY_ 17.Trargponer d Racelpt d Matadab <br /> Trangxrter 5g Mmtlr Day Year <br /> J `44 2 � <br /> Transporiv-2-Prii6rhypid Name Sig ahrm Month Dal Year <br /> 10,Diwepency <br /> 1Ba Dgaepancy krrtication Space ❑ Duo" ❑Type ❑Residue 7"Partial R*d, ❑FW Rejection <br /> rii Reference <br /> 18b.A.hernate Facilk(or GeneraScr) U.S.EPA ID Number <br /> _i <br /> u Fadray's Phone: <br /> 1 Be.Signature of ftcr m FaaGty{or Generator) Mora OMYem <br /> ui 19.fiaurr&ws Wash Report Management IAetflod Codes(f.s.,codes for ham*w waste heahneri 06patial,and racyciFtg sysiew) <br /> Gi <br /> 20.Df97 <br /> Fac7ty a Certificahanolr�ecaptofh,a�cwsmde r�wreebythe+nanifeste�ept inllam <br /> Pnntarne ,Ve , arm 00 22 <br /> (Rev.12-17) Prefod ed' ore olrsale DESIG F To EP s a-MANIFEST SYSTEM <br />