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"vq f,iq <br /> T <br /> Please prii it,or typeklcorm designed for use on elite(I 2rpltch)typewriter.), Form Approved.OMB No.2Qa0-0039 <br /> 1.Generator 10 Numb ir Emergency Response Phone 4.mahifest Tracking Number <br /> UNIFORM HAZARDOUS I -4 S8-17 6 0 `4 6 <br /> T i-1'% 0 i 4 �3 0 SKS <br /> 4 100 10276 <br /> WASTE MANIFEST I Generators Site Address(II'diffetent than mailing address) <br /> 5.Genaraioes Name and Melling Address <br /> % <br /> Generator's Phone: 9 j P,-.4 4%4 <br /> 6.Transporter 1 Company Name U:S.ERA ID Number t <br /> SYS 1IF"Id I'E' <br /> U,97EPAM Number <br /> 77-finsporler 2 Company Name <br /> CLFAN HAP-90611S VIV11�11IN--NTAL -t.1910 <br /> 8.DesignatedFactlity Name and Site Address U:S.EPA ID Number <br /> DPRPYFr3"N1 ROAD <br /> CA mm <br /> Facility's Phone: <br /> 9a� 9b,U.S,DOT Description(including.Prop0SN 3ping Name,Hazard Class.ID Number, 10,Containers 'ijjotal 12,Unit 13,Waste Codes <br /> HM and Packing Group(if ani No, Type Quantity W(,Nol. <br /> 2-2-` <br /> Rc?o irozo qoomi�,, wvo,!-, 9"Ol..t 0113" !;int Qtam <br /> 0 <br /> r�n Yl <br /> - <br /> ✓ <br /> -T- <br /> 4. <br /> 74.A-Speclai Handling instructions and Additional Inform tion <br /> M., <br /> .ard <br /> It blot,OrMdwliar w are ciassitied pii <br /> arked and IaUladlpl6car <br /> ded,,.gnd are 41 al('rei 10(41properiandillowfor ttanspwiC`cw496'6 applicable IrtlemalloPel and 08116Q,goverom e6lal.re ns.-(f��jpoI�'shipment and am P nri <br /> ntents of this consign.ant 16 he Acknoviledgment of Consent.Exporter,1 the 1 161 terms the attached EPA <br /> I CA <br /> IiIii It.I In 40 CF0,282;2T(q)(If I arri aIarqe quantity gan9mtqr)orW)-(if le aernall quirdity ganbrator)Is true.." <br /> at ple-ffiblifiza(lonstate -At 6 <br /> 7 Monlh Day I Year <br /> -0. n YPQ <br /> F 16 <br /> ener er <br /> j <br /> Intern nal Shipment Poftf bintryt.,11: <br /> Import I UZ. ❑Export from US <br /> tor exp <br /> Oda onty)f we leaving U.S: <br /> - <br /> IX 17,1'rensporterAcknowled Is <br /> gment of Rei of Miateda <br /> LU Day <br /> Tria—nsp� Printedrryped Name <br /> 0 <br /> a. .-�,/ hionin My <br /> Trans s r2 Punt I Y�ed <br /> $ne,,y ITYPI <br /> 18� screpancy <br /> 18a.Dlscrepinoy�Indication Space <br /> Quotity-, <br /> Manifest Reference Number: <br /> U4,EPA ID Number <br /> Fa111y'(or Generator)llb.AI(emate <br /> -4 <br /> —Momb -�-Day j Year <br /> I., Facility's Phone: <br /> rGeneta(or)! <br /> Signature—OrARemiate Facility <br /> tZ719,Hazardous Waste Report,Manage on Method Cc Jos(i.e.,codes1or hazardous.waste 4ealmott,disposal,and recycling systems), <br /> 3. <br /> LLJ 2 <br /> I of hazardau <br /> th <br /> 9. <br /> "4eiorbpBfatof,Co... 0.6 17 Month Day; i Year <br /> zd;0 q,Ig p g;F-0111.,(D <br /> milur <br /> Sig <br /> Prmed N V <br /> 1!611 <br /> -NATIrD FACILITY TO GENERATOR <br /> EPA Form 8700-22(Rev..3.0 e d lion an I C <br />