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Mew)pint or Vpo.(Form designed for use on elite(12-pHch) 1 0 B No.2050.0039 <br /> UNIFORM HAZAMOUS. A.Generator ID Nwnbct z.pap 1 of S.EmWcy R"=Phone 4.&lanifestTracking Number <br /> WASTE MANIFF-STr f8rt <br /> -I,) 4-A-9a0f,' 00988951 8 Jed <br /> � ii� �, � <br /> 5.&rarators ame and MgM Address <br /> GentraWs SM Address(if Wlefefit than Malling Udd[66s) <br /> N <br /> JR�r- LIAIE '-9ZM-,' <br /> Z,W E.iQj--=LF-W1,J R0. <br /> /•'. <br /> P;152 <br /> Ganeraws ph"; Iflia+Izlallarrw <br /> 5.Trarlsporter I Company Nam U.S.EPA 10 Number <br /> A:'Nqt iRy=P'N' 17 0, 2 -3 2 <br /> 7.TrdnspoWZ Company Name A 0 Number <br /> 8,N;j9d Wity Nameand She Address U.S.EPA 10 Number <br /> '—W'a <br /> LOS 16JI-IGELES CA <br /> 9b.U.B.DOT De$j*6*n(including Proper Sh*Lng Nama,ri2zlrd C-L-s-1,10 NU-tuber. 10,contahers 11.Total 12.Unit 13.waste codes <br /> HM and Pack1ngGmup(49AY)) Na Type Quantitty WLNOI. <br /> r,T'x <br /> w -REGEWED <br /> OCT 06 204 <br /> L <br /> 4. <br /> ENVIRONMENTAL H AL7i H -71 <br /> DEPARTMENT <br /> 14.Special Handling WM6=and AOM60U Informarlon <br /> ' r,, - I Lr 17' ZGFI LE 981 A-P!TT'2w 01 LY OS P <br /> ac-Rosimw j-ao-,4,, , J 'f PC <br /> -- . !P�VR <br /> Al`1 C! 61 tri-3 <br /> - * <br /> 15. GENERATOP'S1OfM0fV8MnFICATIDN:I hereby dedam that the contents of this consignment are lulY and awJ UUWA S;d above by&pmper **g name,and are classilied,packaged,Primary <br /> eN= <br /> marked and labelediplawded,and are in all respects In proper cOMI'm(v acmfdn to App6mbig intarlatIonal and nationalgoyamwntal rqulaWM Axwl am I am the <br /> Exporter,I certify thatte contents Of tWg consignment conform to the terms of the,au:Dchod FPAA6mffwI9d9Mant Of CM89i <br /> Ica*that the waste rMknzftn statement idenbTmd in 40 M 26ZV(0)Cif I am a lArga qu2n*Enerab6 or (Alanifismall lerator)ts no. <br /> is PrintedlTyped Name Sul <br /> It <br /> =.j 16.1n Shipment ❑ El Export fttm U. Pal Of <br /> D Import ❑to V�S. Date leavi U.S.: <br /> Transporter signature ft Mot 01IM: <br /> LM 17.TmWnw AdMOVAMPM1 01 KecePior"1310"al$ FA Y <br /> $Iva <br /> me <br /> Day Year <br /> -J <br /> 18 Discrepancy <br /> I ea.Discrepancy Indication Space Quantity El Residue C]Pwlfiml Rejecfian El PA RaiaLtion <br /> WOW Reference Number <br /> 1 8b.AjIemje FaUlIty(ur ciffiBrati)F) <br /> r4onin Day Year <br /> LLI <br /> <t� Facility's Phaw <br /> r Generator) <br /> wdc3 for 1-aza'does wa4ka veasmanL dapoW,and mcycfing WSIQMS) <br /> s. <br /> tat <br /> 2. 3. <br /> ZQ,D"Wd F or Opera CervUCaUO,1of1�iptofhazard material co dbyftmanifest ffXcePtfiSn0iWtnIIem'1 fag Day TM <br /> PnnIc0yp*d Name <br /> LPA Form 8700-22(Rev. Prom r,066nintg gra dw%ls. DESIGNATED FACILITY TO DESTI ATION STATE(IF REQUIRED) <br />