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Please print Ur type,(Foan defined for use on elate(12-pitch)tipawrlbr) orm Approved.OMB No,205HO39 <br /> UNIFORM HAZARDOUS t.C*nerAx ID Number 2.Page I 111 3.Ernergency Res?w-se Phone 4.Mmffad Trach*Nmher <br /> WASTE MANIFFST I CALOOOiS21345 I-. 1 1 ("0-)4z$-5+3;00O;-Q863149 JJK <br /> 6.CQ=2ws Name and MWIN Address Garmtor's Site Address R aerent than mAng address) <br /> J IFTY LU aE.FF2322 <br /> 500 E.KEMEMIAM PD. <br /> LODI <br /> GeneraWs Mona: 205329-0!5 0 <br /> 6.Transporier 1 Company Name U.S,EPA ID Nwfter <br /> ASBURY ENWOMMENTAL SERMS5 CAD02927703i�, <br /> T.Transporter 2 Company Narma U.S.EPA ID NwribaT <br /> 8.DesIgnal9d FacRy Name end ShAddrass U.S.EPMI)Nufter <br /> SIEMENS IHMSFRY,INC- <br /> 537'5 501UTF BOYLE AVENUE. <br /> LOS ANGELES CA 90053 CADOB7030,993 <br /> Faaws Phome.- (Z)2:31277-:1500 - <br /> ge. 9h.U.S.DOT Dawipiion Wag Prowftphg Narm Hazard am,ID Number, io.commers 11.Toni 12 UnIt 13,Waste Codes <br /> 14M ami PaddNGip(d-y)) No. Type Quantity vvuvol. tt <br /> :352 <br /> 0Sr D v <br /> f il <br /> IGO <br /> L <br /> 6NARnNUFNIAL Hsal <br /> EALTH I <br /> 4. <br /> DEPARTMENT <br /> 74.Spedal Handling Inshudons and Addilonsi Information <br /> EMERGENCY CONTACT;CH EMTREC i,900-424-9'300 NA;-:RG#961 17i FROME OB-4 APi6T,2?5,h-,5fl:Y <br /> 8000.5 Ir FG*A101638-97�APPROPRIATE-PERSOMAL'PiROTEnt YTE <br /> M.I hereby dedars Wj*cwisnb of ft cwx.7meM am fully and d—ibed above by the VOW 3MOV name,arcs are dasmea,pzlc�lqea, <br /> 15. GISNERATOWSIOR-E oKsCERllrICATI <br /> marked and jubojadIpkc=Ied,and era al respects in proper cmd4on for tangport according applicable 9vienlalOft KWMIDM.9 WqW 6114)(Wt and I am the Primary <br /> Exporter,I certify W tho Wntugs of"corisignmenj=forrn to the Wens of the atb2dmd EPA ArImmledgrywnt of Consent guanfity gan,.aralod Is true, <br /> the waste n*an"ron smjamp.t identified in 4()CPR 76227{¢)(d I am el;vga quantitygenersM)or(b)(If I am u mall---- <br /> rsjLm s tr <br /> 103 109 1 <br /> Import to U.S, ❑Fit f.U PGA of eabyla:* <br /> Trw,tipwtw%Apature(for w9xxW 0*)' <br /> Data leaving U.S: <br /> L Of '17.TransporterAcMovA*n-,ent of Rfiuttof M*A21s Month Day Y&-., <br /> Ll <br /> i Prinleciftyped Narne 9 <br /> 2 <br /> Q- PkA) sigraffe Moft Day Year <br /> w <br /> 5 <br /> I18.91scrapzncy <br /> isa-Discrepancy inskoban spaw ❑ []Type- ❑Partial Re*don ❑Full llcj . <br /> ftft Rgerem NWO-V U,l EPA ID t iumbw <br /> I 9b.Allarnalo pAdily(or C-Anergldt) <br /> is <br /> racilhyk w n a mol :-dy LMY YCX <br /> i ec.signature ot Piternate FacRy(or Gonarator) <br /> tl <br /> 0 codas fx — —,i. &P6021.and fwdN wj;�U=) <br /> O1J Codes 4. <br /> 2- <br /> BELW ki�am Ida <br /> Pd Ye- <br /> 9FA-VMft 977-22(Rev.M55 FRMOUS edq=BM DUBi*- DESIGNATED F=Ctii TO DESAINTION STATE(tF REQUiRED) <br />