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0 S 17* e f '863108 • 47907 <br /> Pk�asa print or type. Form designed for use on elite(12 ach) writer. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1A 3.Emergency Response Phone <br /> WASTE MANIFEST 7239 (877) 577-266 0 0,� 93336 <br /> 6.GerweWs Nene are MANng Address 14S Generators Sb (t NOW than mating address) <br /> MR MW C/0.36 CMANY =DIM #011116 <br /> 1915 AM VMS #111 251 camel AB6 <br /> UwalopawCA 92118 (811)451-8346 KAKVC& CA 95336 (219)825-9139 <br /> 6. raneportar perry Nese U.S.EPA 5 NuR—w <br /> CNEW EM <br /> CNMO <br /> 21st EPA ID Number <br /> 1�6`4�0y 2 ,�t ^� <br /> 7. ` 2 ane E. 5 U v Zia e„!(J OV <br /> 8. FecEty AddressU,3.EPA ID Number <br /> rMum ALe IK. 1w FACILITY <br /> 20245 iTl1 A <br /> F I>hons: URP U-98132 (253) 872-8131 190991281767 <br /> 9a, 9b•U.S.DOT D64011plice(Irx udN Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Una 13,Waste Codes <br /> HM and Paddrng Garp(t may)) No. Type Quantity wtjw. <br /> 1. , 8, 1.0.5. ( ) 0#11 D/35 331 <br /> 2.1 off-S112842 lo( 1=111) , -DW. 0096 . P <br /> 2. 11 R35 331 <br /> 3. e <br /> R F <br /> 4, ► t <br /> wormation 1) <br /> 1 . krg Ina �( <br /> (1) 2.1-13 - (126) as <br /> (2) -/. - (121) F <br /> 19 :24 W IMMENCY CWACT: (111) 451-8346 <br /> 15. OWRATWSWFEWS CERT'FICATM:i hereby declare brat the cants of this cons%nrirent are posy and above by the proper shipping name,and are d9selaed,packaged, <br /> marked and lebelediplecarded,end are in all respects In proper condition for transport acwWq to applicable Internatiomiland national governmental regulations.If export shipment and I am the Primary <br /> Exporter,l om*tent are emir of this=WpMt cadorm to the terms of bre attached EPAAd wMWg=O of Consent. <br /> I r that the waste minbriftedon statement Ideallfled In 40 CFR 262.27(x)(If I am a large Ww* )or(b)(ifI son a snag Wisi ft Is true. <br /> Genemta's Mror's PdrdadlTypad N UE Day Year <br /> 16.International Shipments D Import to U.S. ❑E t from U.S. Pat of entry/exit: <br /> Transport*nature(fob exports ON# Date leaving U.S.: <br /> 17.Trm%WW AdmWedgment of Receipt of Materials <br /> Transporter 1 Printedliyped Name �9 Signature Month Day Yee <br /> jffpl Eta M 1 <br /> ranaporter rim y)ad Nene Month Day Year. <br /> 19.Discrepancy <br /> 16a.Discrepancy Indication Space Q Quantity ❑Type ❑Residue F-1Partial Rejection Full Rejection <br /> Indication <br /> Manifest Reference Number: <br /> j 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> w FacRIVs Phone: Month Day Year <br /> i= loc. %nature o a Alternate Facility Generator) <br /> 19.Hazardous Waste Report Management Method Cafes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 20. Fadaty Owner or(terata:Ceft don of receipt of hazardous materials covered by the manifest except as rated in item lb <br /> Month My' eer <br /> EPA Form 6700.22(Rev.3.05) Previous aditons are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />