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i <br /> 3516fI i7 jr 2628220 <br /> Please print or type.(Form designed for use on elite(i2-pitch)typwdler.) "7 7 f Fom Agptoved.OMS No.2059-W39 <br /> UNIFORM 1 HA7ARf}ous 1.Gerteta!a 10 Number 2_Page i of 3,Esneroemy Res4o w Prone �4.Manifest Tracking Nu nber n <br /> svasTEa,Rfa1FESY CAL£IC1E1: 91073 ?_ (13771 �7?-266fa oa ?i DAT <br /> 5.Generators Mame and MaMngAWws Generators SileAddress Ct r}uerenl Bran rna ung add=s) <br /> DIG LATS STORES IIIG LOTS 94457 <br /> 3d� P13ILLIP all MR: DFM FERA€lU PISHI N_ TROCY DLYB. <br /> GeneratoesPhone: CC}LIMS [IN 43228 (5141278-'4614 1 TRRCY CA 45376 <br /> 0nansporter 4 Company Name U.S.SPAM Number <br /> 21st Cen-Etary EnVironmental, rjana<iemertt of California, LP CAR00102101517 <br /> 7.Tmmpokf 2 Coagvny Name U.S.EPA ID Nvn"6erV'X-4(X;V0V- 1 7 ZZ <br /> 8.D 'rtaled Foaty Name aril SheAddress U.S.EPAID Numbor <br /> 2151 CENTURY INVIRCMMIRL NM MME3tE}Y OF HEWN, LLC <br /> 2095 Bulaads Drive East <br /> FacaiIi (775 - bIt U wir,i'na <br /> ca_ 9D.tJ.S,0C3T O Gpn(';mChrduig Preset Ship,'ring Nam,t',a�.rd Crass,#p Muco r, 10.Containers 1 t.Tata! 42.Unit 48.waste Codes <br /> HM end Pa$iNGrtwp(dany)) No. Type Quantity Wtivot, <br /> I• UN1393 UASTE FUMIKE MUM, H-O-S- (1{EROSERF, PIESEEI 3 FGH ]] 331 D661 DUDS <br /> X REI1>1UU1=1DD) -pre <br /> l <br /> Mill DBIR A535 <br /> a. UN1791 VRW HYM8 I'TE SOLUTIONS E P61I d�) [Z? D082 <br /> I <br /> M3077 HIMPOS WSTE, SOLID, H.A.S. (nERCURY) 9 M11I ROD9139 �[81 alUD9 <br /> v M r_ <br /> 46 -- <br /> ..,. <br /> �fn��tet In f~�iti4. �urrf u!•r rw . .a« <br /> H'x`3•"7.:":SH HIS) <br /> IG,Special HaMJimg frstruCSSxts tivJ A.ddtipr;at fn(ocmatiort ' <br /> 6(1) ILFLMR-92f EA6#3.281,ET.4ttlii�rll<!,E LIQUIDS 121,i�ftCT'EACH-H = ERG11541 U1,aM 01 ILCRSIIIU.B-02 - ERV1711 G9USHED <br /> Hi T r,- !.sy Mhn. Vnw <br /> 15. GENERATORSIOTfIRORSCERTIFICATION;therebydeclare(3raithscoMentsofliuswrls:�lare fuGyaid aommlelydmcrZWabove"pro¢Cfjwm.Afdwedmtr .pad(arjeo. <br /> marked and fafx{edlp wded,and are in al respects in pepper wnTjGpn fortmnsport aoccoratg to alykcaUe inlernalic W and nat anal gov wawntal regulet'rorrs.If expod ship hent and I am tha Pr'vatfy <br /> EWAer,I OffYY that#*content$of this cctmkjfunent conform to the 1w..rs oMw atrartfod EPAAdaw*dgment of Censcrrt. <br /> I Eertifyrhat nre waste nf§vr;iizatiut ataS4s,>ertt;dentfied&r b4 CFR 2(7.21{a)("d t am a large quantity glory or{b)(df am a smart gpan generator)is rare. <br /> Gem at s!t)iferora I'miedTyped Name 4 me th Day Year <br /> 16.Interna I Sh pn es,Is { <br /> [ranst ortersknat<na{for ❑I°tp7!!tp U.$. t_I F�q ort from tl.SenlryfoAt. of <br /> e�rtx Cray): Date rea)i U.S. <br /> 47.TMISWg Ad nmWgr nt of RM 40fMaJM* <br /> Uj <br /> Trans cr1PrntcdlF Name Signature Month Day Yeat <br /> ul. o 111f�C.-{.G � / <br /> iranspo�jter2P tediTypedN sign 4tre ASpnb flay Year <br /> 18.a'saepancy <br /> 48a,)}istreparfcylndcalionSpace ❑ Quantity QTYpe ❑Roidcm ❑Far&at#2*6, L.] v6f2el tion <br /> Manifest Reference Nwntaer: <br /> 18b.Alternato Facraty(or Generator) U.S.EPAID Number <br /> ca <br /> Fanlity`sPlaoe: <br /> Uj 1 k 5.9-Ue dirt rr t FarZV(or GLtafor) f Day Year <br /> d <br /> z <br /> 15_rfararckr 4Waste4t2portii ,ajgerr lMelljodCodes CLe.,aodes forhuaardo"cj*wWetrwVfi rd,dispwal,ardrecycTr WS toms) <br /> 14 <br /> 2{3.0esigcakedFadCty(h4rretcc0pemtor,Cerfx-aWofr--mi,.ofhazardousrriaWr tscovered bythe rnWestexceptasndedin 4fla <br /> Printgdlryppc! 2�1T ignatrrra Mprsbr Day Year <br /> 1 <br /> EPA Form 8700.4(Rev.3-05) P:ev';n,meditionsare cbsolete. JANt}ESIGtV/iTE t'f� iLE7Y7QDESFi�lAT'ION� FA-TE(IFREQUIRED) <br /> � g <br />