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PE-ase i.•i4m-tFarm desigr.ad for use on elite(12-pltch)!ypewdter.f FWmApptoved.DM6Ido.305M39 <br /> UNIFOR M HAUfDC)U$ 1 Gereratcr ID Ntxrber 2 ?age 1 cd 3.Emergency Response Phum 4.Yantfeat Tracking Number <br /> WASTE AIAMIFEST ' J J K <br /> 5 G: gralYs li me aid frEakg Addmu Generalces Si fe Address{dddferent than ma lirg aft=) <br /> . —Ito Ito Party X043 Savy Dr <br /> :ivy Ps <br /> CA DSJ0S <br /> Gsna•at—Phone. 334 310-3179 <br /> &Tr3aspoaer l Canlpi(fp Nm U-S.EPA ID Number <br /> ;d. Rscov ry CW00175492 <br /> 7 Transr M9r2 Gdllperry U S.EPA la Number <br /> E DwsgatedF 51EeM 1 `, U.5.EPA IDNurber <br /> r.a�1CAI SO-UltiMd LLC ATun. <br /> W. P3.rst Straght <br /> Feud, pyrone: ILL L" C.�p <br /> 9a 9d UA GOT (Inr*dm PrawSNpping Name,Hmrd Class.ID Humber. 10.Cut iriafg iT.Thlal 12.UFA <br /> W and Pad:np Getup(6 allyl) r.:.. T}pa GUN* t4R W 13-Woe Codes <br /> t � � •o n 3 ti <br /> [C <br /> DG <br /> W <br /> _. 1¢ _`..:1-15- Y JlaeLLKZOR4 Ind Add taW kikroulmi — <br /> » WMr VMx F.top" tK Clothing;: 4[ri of dYtamr9anCy CAtktact L'ojaffm {r, <br /> ;t+0 A+bgi�triz~nt t��lr'�475•- 5173:• <br /> 15. GENE RATOR'SIOFFEROR'S CERTIFICATION: r hereby cedafe Mthesanlerds d#&cwvugnrwnt are!L-.;,and amuatety OgscNnd abo"by the pmw shipping na(m,and am das3ftd,packaged, <br /> rnarkrd 4d labdedf bewdad.and Aro m a-rospmcts in Proper 0rxi18oa AN lrar wow aimordtng and nada ml gave mmenW nequlalians.N en?xt 919pmerrt and I om tnu Primary <br /> Emu nor,I oaMYy tfmtlhe axl"of!Itis eansign cyst 60*ft to the tams tithe adKW EPA Aclo+avA grnmt of:'cn--ni. <br /> Inat the waste ftM ahm s mem N sanded In 40 CFR 26327{3)ip I am a Large quan"s}enerator)-: r .d.a:r a small, , rr r.e is true. <br /> Garr "i endo fiinRedfPyped Nine r. : re rn Day Year <br /> J 16 c <br /> 1d UIS G Emm Tram us- Pon of gr&y*xd <br /> — oNyry: OaEe teanrg U-5.: <br /> � ' - - --'a'#ncaSedgmant of RetPipl a Aielarials <br /> ce ranNarrr 5igretulre hu& Day Yaw <br /> C) <br /> 0. L - :, , <br /> _annted7gedNarne l.S" Day Year <br /> a <br /> Ia.01wepov <br /> 16a D xrenart,y lydc8bw Space 11 LJ rfp,- 11Residue ❑P.rdal RcyecSon ❑Fu I Rejedvn <br /> 14nNst Ralemnce Number: <br /> 181} ^ary:}..,_'it rar GcneT-jt6 U S-EPA IO Nu7ber <br /> zi <br /> [.a <br /> Ids. FatdysP:xe <br /> Uj <br /> tec S.cra:..-olNtemaeFadiry[dr gPrdlOr, ?�^r, "a. <br /> Q <br /> Z <br /> 19 Hazer: a-t•rem LteUW Codes(i.e..mdm forhaxardoz wasle Vea meet drspasal,and ecyrlmg systems) <br /> 4. <br /> iO Dasg, .:'1^km.w of tragr.Cer1IfPco5 n of receipt o1hezrrd xm rrL-erui s coy"by".he man:fes!except a9 noted in!trn lea <br /> PtttbiT);• : - Sgnn4re Mcet pay Year <br /> i <br /> i' <br /> EPAFarm 8700.22(f Plsr OWedibonsare obwkrW. DESIGNATED EACILITYTO GENERATOR <br />