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Form Approved, OMB No. 2050-0039 <br /> Please print or type. (form designed for use on elite (12-pitch) typewriter.) <br /> 1. Generator ID Number 2. Page l of 3. Emergency Response Phone 4. Manifest Tracking Number ®�� <br /> UNIFORM HAZARDOUS f;s'r0633W8253 ® O p <br /> WASTE'MANIFEST CAM144r35n r Generators SileAddress pfdlferenf0sanm fling address) -- <br /> 5. Generators Name and MailingAddress ATTN:GUryrj2bl ?SP !I <br /> Tr� nflihil <br /> Un D:& k'# TrEt.. 11 Sf.�� _ <br /> 1&? . YLOVIPI 348 11 t5t - <br /> fr CA <br /> Terms CAM76 <br /> Genemtors Phone: � -3 � � <br /> U.S. EPAID Number <br /> 6. Transporter l Company Name - - <br /> t1T T�, ( strenta}(:«AsER Pim+E•tu�tlD R7B Ufi "'° ) U.S. M P747 <br /> 7. Transporter 2 Company Name G, y43 <br /> DIVaInd ErlilifluDirlinelliI 9kVI <br /> U.S. EPA ID Numher t <br /> B. Designated Farepty Name and Site Address. <br /> Carriturit E S a§c s LLC lRfl127v21 <br /> SM Old Faris Rd <br /> Facilitya Phone: 2"r C3^7`I3 5 <br /> 96. U.S. DOT Description (iricluding Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 72. Unit 13. Waste Codes <br /> HM and Packing Group [ifany)) No. Type Ouantiry WtNol. <br /> Y,peRkk#G.7' �xdauS; Giif U43Tid (PN11F REE2E) 3 <br /> Let <br /> 'Iz WOn-RCRAHPMrd V S18 UgUId (OP tg , 01) 223 <br /> I <br /> i 3. <br /> Nan-RCRAt#s ^;lD9!S SilfaZts Wild (OIL, .ANTS) ID <br /> It i's" j { <br /> = 4. <br /> i <br /> 14. Specht Handling InsWctilns and Additional Infomlation <br /> Dia TTeni 3 Sifts ceder 65519 <br /> y )P 7h1Q J9fiII?9E <br /> DOTERf l ss ° e 4 ^ a •cr t [ <br /> 7FT't'($L+rr ' U�'I *.�J.11 ..Fl F CYFfaI. ( S <br /> 15. GENERATORS/OFFEROR'S CERTIFICATION Ihrbyd Ih tlhe lents OT MIS gn en[ we fully ndx 'accurately described above by lh propersh pp gna , pdareFlass fled, packaged, <br /> marked and labeleNplacarded, and arem all respecs in proper condifion for Mankind according to applicable ntrnationaland national governmental regulaM1ons. if export shipment and lam the Primary <br /> Exporter, lcemfy thaC .t nlenls of lhscons gnanam conform to the terms of the attached EPA Acknowledgm f fConsent. <br /> i Icedify that thew stejrpinlmvalionsralement rdenUtiedin 40 CFR 262.27(a) (d l am a large quantity generator) or (b)jdyam as small quantity generator) shoe. Mew Day Y ar <br /> GenemlorslO((erclr 1�n 1e ypad Nam . ��.� / e,�..a-- S gna`re `� .re� <br /> .� 16. Inlemation5l Shipment'sLiExport from U.S. ! Pon of entrylexit <br /> t- HImport to U.S. ` DaleleavinI-` - <br /> z <br /> Transporter signature (for exports only): - <br /> w 17. TranstoderAcknoxledgment of Receipt of Materials Signature Month rDay Yeearr'7 <br /> ff� Transpodert PrintedfFyPed Name 1--Al- � q <br /> wal Signature - Month Day Year <br /> 6 Tmnspo g <br /> Primedr<yped Name <br /> 18. Discrepancy .i <br /> 18a. Discrepancy Indication Space <br /> ❑ County L1Type ❑ Residue ❑ Padlal Rejection El Full Rejection <br /> - Manned Reference Number: <br /> U.S. EPA ID Number <br /> � � 18b. Allemate Facility (or Generator) <br /> U <br /> ua- Facilltys Phan!: Month Day Year <br /> W 18c. Signature lfAitemate Fadlity (or Generator) <br /> Z <br /> 2 19. Hazardous Waste Report Management Method Codes (i.e., modes for hazardous waste Uealment, disposal, and material systems) 4 <br /> 0 1. L. I J. <br /> 20. Designated Faddy Owner or Operator. Cemficafion of wassI Luau d us materials <br /> revered by the wariest except as nded m Item 18a Monfh Day Year <br /> Prigarg yinad Name 1 Srgnatum a r+�T.,._ `r <br /> EPA Form 0700-22 (Rev. 3-O5) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO GENERATOR <br />