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' I-roase print or , Form designed for use on elite(12-pitch)typewriter.) <br /> r UNIFORM HAZARDOUS 1.Generator 10 Number <br /> WASTE MANIFEST 2.Page 10 3.E Farm oved ' <br /> 1.r.Rir+?EL?5.^i„ mergencyResponsePtmne htantfestTtacRingggNumbei <br /> 5.Generators Name and McSrng Address Ir?.a,1•t.g?I� Hy2 ,@ <br /> frf�#Cf3Rp rig. f324 <br /> i 0.196( Generators Site Adders pfdltfeiantth...... <br /> 1 ST0s KTijN,CA <br /> g+" + <br /> A <br /> it/lhly1r� i <br /> Generators Pbona: —, .�Ts`Jkn'r •..CA6.Transporte i'CompenYName �. 1m. (bf1Z <br /> George W.L ,tflc U.S.EPAIDNumber <br /> 7.Transporter2 CampariyName „ <br /> 5Mi <br /> C6; 'Xsd7919 <br /> rested FaO and Site Andress S' r <br /> _ U EPA ID Numbs <br /> a i6sQ E. <br /> R INC. <br /> LR U:S-EPA O Numb <br /> _ et <br /> F Phone:: <br /> 9b.U.S.DOTOeaaip@pp fRdtpg Proper Shrpptng Name,Mezard Gass,1D Number <br /> HM- andPaddngGioup.(dany)) <br /> 1. i8 Containers it.Total 12 Unit <br /> tQCd ''l • &tuft e& <br /> f3 waste Cod <br /> thmntgy wwp1. IS2 <br /> cn . <br /> 3. <br /> 4. _. . <br /> HEfiA.! Fa RC QRTy AIT <br /> 14.Spec[ Hanging InsbucBOns andAddf8onel bdarmagan <br /> 'fiP 9 <br /> PROFIL ,f!37 <br /> � 1" <br /> 16. GENERATON91 FFEROR'S C <br /> marked and tabs ERTtFIGATtON:I hereby decbre that Qie tmnferds of 8ga bonargnarent are <br /> Plaided,amt are to all respects In AroPercondigon for transport lWyand a efy 6esal6ed strove by the gropers <br /> Exporter,I cer8ty that the contents of this.con " accaidaig �tpgcable fnteme8onal and natlonalgovemmentN regulations. name.and are desstfled,packagad, <br /> i cerdly That the waste minim 8�ent mt�to the terms of the af�ched EPAAcknogAadgmerd of Consent. eguta8ans.If export shipment ell t am the Primary <br /> GeneratorstOlfe a Pdnte mon statement ideniIfred in 40 CFR 282.27(x)(If I am a large.quantlty 9enerabr)or(b)(dI am a snag <br /> dlTypd;Nar r 9uanUtY9ane[ator)Is We. <br /> Fest 16.t, rronat Shlprnants � ' f � r r�`^' J Month Day Year <br /> ? 7ronspoders nature far (MP�toU.S. t--r t,�' - 1 <br /> I9 ( exports only): 0ExportfmmU.S. Portofetdryl <br /> x10 17.7rmisporMWrA psyf <br /> Q T 1 adgmenf of RacetpE of Materials Date teav+ng U.S.: <br /> r:tTL�a <br /> TrarrsPorter 2 Pdnted?YPed Name hkn>fr �Y Year <br /> � Sigrmgrra �' /' <br /> 18.DlsrxaPgn�y Day y ' <br /> 18a Discrepancy tndlragon Space ❑ Ouenuty <br /> ®Type _ ..._.._.O Restdtte ❑Partial Rejection 0 Fug Rejection <br /> J18)i.Altemxte Facr�ty(w Generator) ManifestReference Numbs <br /> t <br /> FedgtPhone: U.S.EPA ID Number <br /> ys <br /> 18c.S gnakne ofABemate Fadgty(or Generator) <br /> 19.Hazardous.waste Report Management Method Codesfor harsrdous waste Ueaynannt disposal,and Month Day Year <br /> 1 1 g 9 systems) <br /> L t . 3. <br /> 4. <br /> 20.0eNgna d Facfity Owner or Operator.Cer6gca9on Mreceipt othazardous mat. covered by tha manifest axrspt as rated in Hem 18a <br /> rime yp� <br /> Month D Year <br /> Form 8700-22(Rev.3-05) Previous eat ons are obsolete, <br /> TRANSPORTER-S C;0 <br />