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<br /> Please print or type,(Form designed for use oil 610(1?-pitch)typewriter.) F MPoved,ONIB No,2050.0039,
<br /> i,Generator ID Number I of Emergency Reponse PN .Manifest Track!Vumber
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<br /> UNIFORM HA7ARDOUS 2,Page I
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<br /> WASTE MANIFEST 01 4 Y SKS
<br /> 5.venerator's Name and Mailing Address ciennrithr't Site Addrnqq(if different than mailing address)
<br /> Generators Phone: 9 i G 4—
<br /> 6.Tran8porter I Company Name U;S,LEPAID Number I
<br /> SYBTF-KiMS11 I NG
<br /> 7,Transporter 2 Company Name U.S.EPA ID Number
<br /> 8.Designated Facility Name and Site Address i
<br /> C11'J"Ai'l . HAR0,01 3 SJ0U,S,EPA ID Number
<br /> lAN ,17,fF LLC
<br /> ,pPI K-'RRY�--88A ROAD
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<br /> CA 95133
<br /> 40,6-44 1-09U-2 CA00594943 P11
<br /> -FacifiVs Phona:
<br /> 9a. Vb,U.S.DOT Description(including Proper Shipp ng Name,Hazard Class,10 Number, to.Containers 11.Total 12,Unit
<br /> 1 13,Waste Codes
<br /> HM and Packing Group(if any)) No, Type Quantity w!#91.
<br /> )mt- Nom ,mqn HMAR a U.G )tas-m- soups" Dim - '22-31
<br /> 0 Bhls, pcn-�OLJEWM H MROCAR
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<br /> 14,Special Handling instructions and Additional Informali(n rsi),i Sj 692,--406-19 r-133793
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<br /> 15, GENERATOR'S/OFFEROR'SCERTirfCATI I In ireby dsdi-a.reflwt the contents of.this consignment are fully a.M adcuralely described abovaty the proper s.lippinb name,and are classified,packaged,:
<br /> marked and labelad/placarded,and'aro in all9r1w;16 propeecon0on for transport iccoTclingla applicable Intematfonaland national governmental rqigulollons,11'expod shipment and I am lbe.Ptimaly,
<br /> Exporter,I certify.that the contents of this consignmeI conform to lhe-t;imi of the efiachad EPA Acknowledgment of Consent.
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<br /> ed�that therviaste knItnizallon,statement 149�lfi�'d Ih'40CFR262.27(?)(16 am a iilugo qYanlily (O"a6Fsmall quantity generator)hi true,
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<br /> Ge410estofferoes Pf Month DY year
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<br /> -j 16,International shipments 0 Expert from U.S. Port of an*#l:,
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<br /> Oder signeivro(fq?bxports onIV)"t
<br /> ransperkRowl agmentof R
<br /> LU TonAca ecalpf of Materials
<br /> Transp 'TPdnted(Ty aRd Name pig Day Month year
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<br /> Z Transporter 7POntedfryped N066 Month Day ear
<br /> ifl.Discrepancy
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<br /> 18a:Discrepancy Indl cation SpaceOpprdiTYPO D Residue D'Paillalkejel clIon Full Rejection
<br /> Manifest Reference Number:
<br /> 18b.Afternate Facility(or Generator) U S*EPA ID
<br /> LL Facility Phone:
<br /> le Facility(or Generator) Month L Year
<br /> w18c.Signature of ARema
<br /> ous waste treatment,disposal,and recycling systems)
<br /> hazard
<br /> 19.Hazardous Waste Report Management lAthod Codes i.e.,`,des for
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<br /> Nsigria�tor`Facility Ovineror Operator;Certification of-eqeiO of hazardous materials covered by the manifest excq as qcted In Ilern 18a
<br /> Month 04 Year
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<br /> EPA Form 8700.22(Rev.3.05) Previous editions are orsolete. f DESIGNATED FACILITY Tn G ENE9,AT(
<br /> 1) 711+365M743525
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