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Please pont or type.(Form designed for use on elite(12-pitch)typovaTiter.) Form Approved.OMB No.265Oa39 <br /> UNIFORM HAZARDOUS 1 t Generator 10 Number 2.Page=3Erwrwxy Response Phone 4.tdnniftat Traoking Number <br /> WASTE MANIFEST (�;5-=.4.%)t 00'15 9; tM-8772 3 <br /> 8675 FLE <br /> 5.GtnoraWes Name and ftngAditSS rrora s ' Address(d d,.erenttnan nwng address) <br /> Uj',NLi"R 2.�4V(eUtV. Atli WnVy hi,4(tt oftil <br /> (toi;te±t,CA qSM <br /> Geoera:oesPhone: 71y a, >: x.; <br /> ransportari ompany ma � rx� r� U.Scr <br /> 3- .EPAtONumb <br /> WIT) aci td Lim-,CC) ES" R4ih`4s3.Ftru4n <br /> 7,Transp xtar 2 Canpany Name U.S.EPAID Number"" --- <br /> 8.Des"Ied Face ty Namo and ho OOS$ U,S,EPAtO Numt v <br /> Faa'=fysFrxurds r A4V-5f fia i- Vit,t 6 t34 d t l7 <br /> 9a. 9D.U.S.DOT Dasaip5on(in.l og proW SNppN Name,Hazard Class,10 Number. 10,Contactors 11.Trial 12.Unit 13.S+taste codes <br /> Hist ext Packing Grp(1 any)) No. Type Ouentity "A Wo <br /> i 1 <br /> CCALI— <br /> i • f..fl i k¢'P$1 yatw7 E 'il f'd Y'i`" {"'•f'nf i9'x. 'ft@ r"i f'Y'T....«,is a'.w i'a98 tffv -p <br /> SOL*(NOrr'C)O t !0-� S 1Etf r r:1j ��'•�' <br /> 2. <br /> 3. <br /> 4. <br /> tor, pataafHantd3ng±nstructomand Addd—plInformatwn r� <br /> (J-NNAA-SeRVICE PECYCI-Wo PRatECT fojicA.Rw, <br /> 15, GENERATOR'SlOFFEROR'SCERTIF:CATION:lat byth8VWrdiPP[ngfJ"-and araclassiSK <br /> marked arxi am mein at respacts In pmoper tdrdi6on for transM eomwdzng to apOcabfe kftema6onal and national gVern sentst NVAUons.N a pa4 sHpmerft U41 am the Primary <br /> Esporler,I cenify that the contents of ihls mmn Vmefit conform to the tarms of the attbched EPAArknWA*Qgmant of Consent. <br /> I camty that the%as%mdn izaWn statement Identified in 4a CFR 282.27(x)(ifI ant a lard Cw fq generator)or(b)(d I am a"quanOty yenarew)is true. <br /> rear a rmt ypad ama agnawre y ear <br /> _a 16,±ntematSona±shpment; <br /> ❑import w U.S. ❑Eicpart from US, Pat at enlryterit: <br /> Trans ti�napae(for ocorts Wyk Date lesvim U.$. <br /> W17.Transp W rd of RMIP1 of Matedats <br /> ransporter t R.Wyped Hama Month Day Year <br /> Transponar 2 Prinfedr5w Name Month Day ear <br /> 18.Dacrcp�°cy t(�-1t ��11 �t <br /> lBa,DsSmparcyIncitationSpace OuanGy t�iTypo L1Residua ❑Partial Ra ' FutiRa}acxan <br /> Mar>fastRefe Number: <br /> 18b,Xwtnate Fao=ty for Ganerata) U.S.EPAID Number <br /> J <br /> U <br /> Faoa sPltaam <br /> ® lac. i�nature cfArnmale faWy(or Generalor) Month Day car <br /> d <br /> 19.Hazadaas Wasto Retort Managen+ent Methal Codes(t,o.,tildes dor hazardous worsts traatInea craPosat,and racyeq systems) <br /> 1. 2 3_ d, <br /> 2D.Desgna,asd Fac.{ay t?�,rer a Opareta:Carlficxtion tlf recmpt et hazaMous matersars roramd by the mauaisaf exrapt as noted kf Item 18a <br /> Pnntwype9 Namegrsature p y Moro eu <br /> EPA Form 87b4.22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACOY TO GENERATOR STATE{IF REQUIRED) <br />