|
PlBase,prlrjlo'r..type.(lotmdestgnfOrusegrl'e13te(�z-P�tpJl).1YPewntB�j
<br /> Farm"A`PProved;OMB No.2054-0039 :;
<br /> 1,Ge eras rl Nu 6e 2 Pageiof 3,E�.IprgcyRspa�rhone " 4,blanifestTracisingNumher
<br /> UNIFORM HAZARt30US 7 ' a (� e ,71 J+�
<br /> WASTE MANIFEST.-
<br /> 5.Gens rto�saaara �i r�gAddress Gene€afar s Site Address(i(different than malting address)
<br /> {sig, `.4.� tf+' e r 1 _l rr ` qh�) -y r�€e . °yUTH CHEROKEE
<br /> � EE kN
<br /> f�AN!MA 4-10r� k�.) �tLr'�E 1, ��{i9�liJE�y�7GC€�I�L:� ��FV
<br /> IOD CA tJ
<br /> Generalar's Phone;
<br /> 6.Transpo G i.G y a01 +� )'A . 5,� U.S. P 1D 2 i 7
<br /> 7,Transporter 2 Company Name U.S.EPA 10 Number
<br /> ,.< .}}.st; pd "-i:• ..-_ ..,�, _ ,�..,.—. .+' ,,,�.�;:..�.._,,....._: r
<br /> 8.Deslgf sFr4i)-leptnSstAd�l�ess U.S,SPA Iii Number
<br /> =0_K ALANIEDA8 WEET
<br /> CO M K 011 CA 90222 QATOSOOIS362
<br /> Facint=fs phone: � �•'
<br /> go. 9b.U.S.DOT Descttpilon(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13.Waste Codes
<br /> HM and Packing Group(If any)) No. Type Quantity WI.Nol.
<br /> 1177FRI RA TA?AR ,37, W XF.LIQ!)1t3( "PAKCE PLP M)
<br /> LU
<br /> HIS WAS E-S{HFANI 1-IAS HEEN QUALIFIEf7 - -
<br /> Fv1 i PLCYCLIi!{'aR A f THE
<br /> tJ�hict`3hlOfKEF�('OU!d DBA WORLD Olt
<br /> 3: R; GYGLING FLRGILIT. . (
<br /> THIS FACILITY HAS THF NLCESSARY PERN1lT5 TO _-
<br /> RECEIVE YOtJR WASTE S71 REAM AS QUAlr11FED.
<br /> ' 0L.113 EPA NUUIBER IS GAl'b80013362
<br /> 4.
<br /> 14.5 ectal andllrsg.InsUucllansand Additional
<br /> 1p(ormppen, -_ „t:• -- . ._-..--- r F = "-_ _- _
<br /> c f-EE jjjREC �k t"3Q-42440 WOO$T EVZMINAS.:fa'�I��J
<br /> s MALE e 9111:1 B. GENERATOR'S10FFEROR'S CERTiFICATiON: I hereby declare/hal the contents of this consignment are fully and accurately described above by The proper shipping name,ail are dassifed,packaged,
<br /> marked and Iabeledlplacarded,and are in all respects in proper condition for transport accarding to applicable Wernaiionato d national govem�nenlal€egalatlans.If export shipment and I am the Primary
<br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknovwtedgmentof Con
<br /> smolt quanllty generator)is true.
<br /> I cadify that the waste•minlTIzAydn slatementidealilled in 40 CFR 262,27(a)(if I am a large quantity generator)ar(b)'(if Irar�a
<br /> Ganerator sl0fferar's Pnatedffyped Name Stgnature I i Month- Day YeaF
<br /> ::
<br /> l
<br /> r 16.In€emotional Shipmepts 'Port of enl xit:
<br /> 0 t+part to U S;`. I _I Export from U,S. 7/e
<br /> Ttansporlersignature(for-exports only).' Date leaving U.S,:
<br /> w
<br /> 17.Transporter Acknowledgmanl oS Recelpl of Matadors - Month Day Year
<br /> Trags iter 1 PdrrtodfTyped Norge Signature , ] _.,. I y
<br /> a_ ff; 'ar tt :lrff rrf C..gar Yea
<br /> co Signalu�e- Month pay Year
<br /> Q Transpader2Pdnteattyped Name
<br /> F
<br /> 18.Discrepancy
<br /> 18a,Discrepancy Indication Space Quantlly El Typo ❑Residua ❑Partial Re{action ❑Full Re;sellar
<br /> ... . ..',..:,,_.;.,.....:Manifest Reference NoMber-
<br /> U.S.EPA ID Number
<br /> lab.Altemdto FacilltO&Generator)
<br /> Ca
<br /> Facility`s Phone: Month Day Year
<br /> Lu 180,Signature otAltemate Facility(or Generator)
<br /> E
<br /> z
<br /> 19,Hazardous Waste Report Management Method Codes(t,e.,codes for hazardous waste treatment,disposal,and recycling systems}
<br /> LU1. 2. 3. 4.
<br /> 20:Designated Facility owner or Operator. ra-tcellon of receipt of hazardous maledals covered by the manifest except as noted ip Item 18a
<br /> Sigttaltlre i:-.;,� �rtort€fr,; 'Day.• Year
<br /> C,� ff
<br /> EPA fdrm"874D 22(Rev:3 05j Prev,. lous editions are of}solet�.. E}ESINATC3, ACIL)Tli'TO fa EPilk'!D "'
<br /> ;,. r. . "
<br />
|