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K 3111 r 4 2 18 t 39663
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<br /> P16ase print or type.(Form designed for use on 011ie, (1:-pitch)typewriter) t Form Approved.OMB No.2050-003rD
<br /> 1,Generator 10 Number Iga I of 1 Em rgenoy Response Phone 4.Manifest Tracking Number
<br /> UNIFORM HAZARDOUS - - I r-
<br /> "WASTE MANIFEST I I-P 90-46 1--i 7GO
<br /> 10 Ot J,-3 22'.8' . S KS
<br /> 5,Goneraloes Name and MaillngAddress Gonsralor's$itoAddress(if different Than mailing address)
<br /> G i I I r S i t o 31 5
<br /> 214 21 t h. St
<br /> BAC RAMENTO 'U'131 l6 3211/1
<br /> Generafor's Phone:, 9 16-4 4 4 2 V-�2'5
<br /> 6.Transporter 1 Company NameUS.EPA 10 Number
<br /> SAFETY-KL-PF--h I Svc-EM 3, I,'l r"3 TXRMOMO'�
<br /> 7,TransportarMmpany.Nam@ U,&EPA ID Number
<br /> 8.Designated Facility Name and Site AddressILr Q,&EPA ID.Number
<br /> -AM, HAM XW
<br /> S 804 'R
<br /> 8BERRVESSA, ROAD
<br /> 4,
<br /> -
<br /> I ,BOE M'-951 W-3
<br /> 4061-44 t-w' 94
<br /> FacIlity's Phone:
<br /> ga. 9b.US.DOT Description(Including'PfoperShIpp!ig.Name,.HAzsrd Clasis,,6 1166itt%, 10.Containers 111,Total.
<br /> j?.Unit 13.WASIe Codes
<br /> HM and Packing Group(if Any)) No, 'Typo Quantity WIML.
<br /> t. inN 7 13
<br /> NONE NONNIEHAZRA AR 141 w II ST E. 910 L I D 8 D M
<br /> 0 tl��
<br /> MEB'hm PETROL8UM' H DROCARSOM VA
<br /> 2-
<br /> LU
<br /> 4.
<br /> 14.Speclal.,HaVllng InsOuctions and Addittortal,Info 69186403 C 133793 180 I
<br /> HR.,EMEACEMY #1-M-j 4E 4-1760' MK T
<br /> Fl):
<br /> P4
<br /> A
<br /> 15. d9NERATOR'S10FIFFROR'S 61fRf IhCA710W Ia i6y de are 10-tiii conlents;'60(
<br /> 1s Zonsf-grin.Fe,nt 5630y 926cd4riiFdFy hate,and ate cl ssi ad,packaged,matkeq And labbledi-piacarded,andthre i6all.resp I I sInipro* j1dition for applicable international andnailI go nmenlal*regulati'6nsilfexport shipment andlan the ormary
<br /> th eWasle min lmlzallo slalemehtld ritill.adin,40 OFR262.27(a)(!fl am alargo qua nilty 9one t1a
<br /> 'kr)or.(j�) If 1 6M a a qua.Kily generator)Is lrne..
<br /> cartilythat
<br /> Rpurt6r.1 cer6ty-Ahat tho.contents;of this consignmen conforrKpIfid terms of the altachoO.EPAAcknowledgment of Consen
<br /> I
<br /> Offoreesi Pdoledt'r- d N Month -DAY Year.-
<br /> Ype
<br /> Gaiters r'81
<br /> .. .......... 1/k
<br /> 4r��4 hl
<br /> 16,International Shipmerts,
<br /> El Import(0,WS:. 0 Export from U.SPort ofeKtrylaxlt:
<br /> R5 Ttanspo4er'sl§natura#ot exports only): pate leaving U.S.:
<br /> "17.Transporter AcItnoydedgmentof Receipt of MathriattiI.
<br /> Transo. e fln e ype Name Signal Month,;. Day JYe it
<br /> 0
<br /> co
<br /> rite -
<br /> dd MTaSi store- Year
<br /> P-4
<br /> Disdepaecy
<br /> ................................
<br /> Residua Partial Refection I EI,Full.*K action
<br /> s6tepency In dl cal.16n Space
<br /> 18a,of' ETTYPO n
<br /> Manifest Refetance.NuMber.
<br /> 18—bAllemate Fadlity,(or Generator) U,EPA 10 Number
<br /> L�' FacUitys Phow.
<br /> 18 c.Big n @I u re of Allern ate Fachity(or Generator) Day 700
<br /> LLJ Month
<br /> Z
<br /> 2 T9.—Hazardous waste Report management Method Codes(i a.,codos.for thqzardous.waste tretalment,4sposal,and recycling systems)
<br /> 3; 4,
<br /> urt 010
<br /> -�474 T,
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<br /> 20,07�lgn.tadf`.cTtyOwne r'opo tirator;Cerliflutfog ofr(calpt of hazardous materials covered by the manitest.0cept as noted In Itern 180
<br /> Month 00 �Yewr
<br /> Printedrry d Name signatut
<br /> 'a
<br /> A
<br /> ZZZ
<br /> -661067 4;04
<br /> EPA Form 8700-'22(Rev.3,05) PreAds editlo�Oro o ,,�ESIGNATED FACILI TO'GE
<br /> t)7436672/743525
<br />
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