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Please print or pe.(Form designed for use on elite(12-pitch)typewriter.) Fom1 Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST '�0 �' ;;�i 7 1 JJK <br /> L.: J <br /> 5.Generatoris Name and Mailing Address Generators Site Address pf aiflerent than mailing address) <br /> A RADC. F"TERK49 INA, <br /> Generators hone: <br /> 309`—" `' f 1A)LA 9t 786 <br /> 6.Transporter i Company Name U.S.EPA ID Number <br /> 11IMEIN[AL SERVICk-S if!l,0 2 1t 2 7 7 0 3 Q <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designate Facility Name and Site Address U S.EPA ID Number <br /> �7 +liou IH 00YLL AVENUE <br /> Yti{rf(v;r.:tF'? CA 4%1(}11'; 4 AL?U:1 ! 03009;; <br /> Facilitys Phi ne: 1T7-ViP, <br /> ga_ 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and racking Group(d any)) 13 Waste Codes <br /> No. Type Quantity ww'd. <br /> 0 t. N !N y-_PA HAiARDOUS WASTE. (OILY 'it m',) -k�•' <br /> 0 _ <br /> w <br /> z z. <br /> w <br /> c� <br /> 1 <br /> 3. <br /> I <br /> 4. <br /> 14 Special F andling Instructions and Additional Information <br /> ,. .t _.;+.,.• ,::,. L 0-1 <br /> 1.8424-9300 NAf_RG#9(d t 7 1 Y I FIIIF N Elfct APIC)tt324 CMtY <br /> -OLIUS * Kj*A110162743 " APPROPHIAR PERSONA1. P")TFCT1Vf.FQVIPWNT ,• ' <br /> 15. GENEIITOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledrplacarded,and are in all respects in proper condition for transport according to applicable Irtemational and national governmental regulations.If export shipment and I am the Primary <br /> Export I tarty that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify)hat the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(d I am a small quantity generator)is true. <br /> Generatoesirroes Printed/Typed Name Signature Month Day Year <br /> I <br /> 16.trite 11lal Shipments <br /> Import to U.S. ❑Export f om U S Port ofertry exit <br /> Transportergnature(for exports only): Date leaving U S <br /> 17 TransportAcknowledgment of Receipt of Materials <br /> Transporter 1 rinted/Typed Name Signature Month Day Year <br /> O <br /> a <br /> ZQ Transporter 2 Pnnted/Typed Name Signature Month Day Year <br /> 18.Discreparlicy <br /> 18a.Discre Indication Space ❑ Ouanfity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 181b.Altemat Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> 1L. Faal ty's Pho e: <br /> W 18c.Signature of Aitamate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardouf Waste Report Management Method Codes(i e..codes for hazardous waste treatment.disposal,and recycling systems) <br /> t. 2. 3. a <br /> 20.Designate4o Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PnntedlTyped Name Signature Month Day Year <br /> EPA Form 8700-42(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />