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aPrint or type.(Form des' nad for use on elite 12 } ' r) _... ._ FormApmva&WB,Ko:2050= H <br /> .UNIFORM H US 1.Generator ID Number 2.Page 1 of 3.EmeryeIn Response Phone 4,ma Track Number <br /> WASTE MANIFEST CAL("Yk 71? ._577 <br /> 5.Ganamtors Name and MaIRVAddress Generators Site Address(it different than mailing <br /> $JNf,- . -qAt_SVC f#FCY JG 4409 rr.Menddtlrla <br /> 32W {C,0 ST, <br /> 3166 Eton;CA <br /> Generators Phone: 4- <br /> 6. rensportar I Company eme U.S,EPA ID Number <br /> Uroan Paroffic Line CC, <br /> 1.Transporter 2 Company Name U.S.EPA ID Number <br /> 6,DeQ—nalle—d PaMy Name and Re Address U.S,EPA 10 Number pp <br /> i <br /> Facilit Is P t East Carom,U i a4526 USA, <br /> I 9a. <br /> 9b.US.DOT Description Orclu flrg Proper Shipping Name,Hazard Class,ID Number, t0 Coiitalndse, 11.Total 12.Unit <br /> HM and Packing Coup(d any)? 13:Waste Codas <br /> i _..No.. Type.� .. ..Quantlty <br /> 1: <br /> I _ <br /> , <br /> z 2: <br /> Uji <br /> 3. <br /> t , <br /> 4. <br /> C Speaal HandBng Instructions;andAW Donal JM;99 <br /> t_41,IeRSAL RAILCAR NO.t.. der . <br /> t=GG 1 fS <br /> i5: GENERATOR , 1 <br /> 'SlOFFEROR'S :Itursbj Conlants0flhtaonsklnT*—r1d.tugyande+sora�rddibe adebdvebytheprop-Fib 0 gnome anJarecfessMad <br /> marked;and labelediplagard�i, In a raspat#g Uensport acpadmg b applli intarrradoitig#and naflbiiat gm r mstitalfapiRedone,if®xpat sfitpmsnt and'l am th®'PrEm y <br /> Exporter,I Certify that the contents of Dr Dxttam to tantt4 the a 3chad'EPAAdolbwietigtnarlt of Cottsettt <br /> I certify,that%a waste minkization statement kilantifledl in 40 CFR 282.27(a)`, am a larga.quertfit genatator}orjb)(it.am a smed;' nifty ,. � <br /> ro- morrm 777-Teer <br /> ..t 16:Intemat)oi}al Stoments: fmpodtoU.S ' aExpotiffcmU.S. Port ofentry/awt. <br /> T a tixe fa <br /> 17TranspMtar . -is -foilkLU <br /> oE. <br /> renspories;.. 7 MOM" <br /> R' e , <br /> WWI- M" vsylql:�Ilywr <br /> t9:DlsctepanGyr, <br /> t 9a;piscrepanCy Micatlon Space ❑Qua,* t l lyps ®RssTdu®' ❑Paitlai RajaClfon" ❑Full R eciiori .. <br /> 78tisAltamateFeali�,iar,Genaratoi) U.S.EPA IDNSmbsr_ <br /> u.: Fec s Phone: <br /> ju. 78c 5 gnative of AEtemsta Facility(or ter) Mond Day':, Year <br /> }✓ <br /> Hazardous.Waste Report idansgement hiedtod Codaa(i a,csiorhazardous waste treaVnatit disposal and rocycrg.s}stems) <br /> 20,Das(gnatad Fan;i' r}�nar a 0paretar, of reoaipt of ttusrdrxis'materials wvared by'fiha'mer)Ifeat.ezcap .. .. _ Item lBa.. ,..,. .., „<,. ..,� ,,<,,,.; . ....,.�. . <br /> IgrtaCxe' Month y'" Year <br /> L41 J7 <br /> EPA'Farm 87004MR611. Previous editions are obsolete, <br /> DESIGNATED-FA IL.ITY TO GENERATOR <br />