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::Y.. �•:a: .-'.'+�.'+u..:s�:. u a»w..::=5.:...... "'e.. �:.Jwl2=.i••c�•"r' 'E:�:S`L':i.::. �v'.•`:�:i'a '>:::- � ti: L:-tt'.•:::.. <br /> ..�1 ...L �rLik}:-.� +x.'�.. ,rL'4`�o"..1"riv3:...LY+:iw`a�i;��:-:t c.4:ii::.'saL• <br /> Plaass print or type.(Form designed for use on este 12-p1tch}typewi ter.) FormApproved,OMB Pio.Z05T0035 <br /> UNIFORM HAZARDOUS 1.Geaetaior ID Numir_r 2 Page 1 of 3.Emergency Response Pnone 4 monitest Trackingriumber <br /> WASTE MANIFEST CC'F?L Q 0 0 `i�g=y 1 (13OM#L$-1-300 009890669 <br /> 3.GaneraWs Name and Mailing Address C•enarain's She Address(If driferent titan madmg address) <br /> it-i'Pt LUBE#r23:.2' <br /> 500 E,r t t E Ah R D- C q <br /> wrJ2i <br /> Getara>otsPhone ' Juif7 <br /> 6.Transporter 1 Company Name U.5.EPR iD Ncrnbar <br /> 77 3 i3 <br /> i-t.�S'@.+U9RY ERY-Rti.1f�IM>=N ALv�Lirgki4,� C,4002---2 . - r- <br /> 7.Transporter 2 Company Name U.S.EPA ID Nurg sw <br /> 8.Designated Facility Name and Site Address U.S.PAID Nt mb:.r <br /> SIEMENS NNSIRY.MC. <br /> 1"3175 SOUTH BOLE Al ENLIIE <br /> LOS AMIELES - CA 9rvo*3 CAD0971030993' <br /> Facith es Phone. (132-6I�:1 r 7_iS00 <br /> 9a. 9b.U.S.DOT Desc*on(ttidud'mg Proper Shipping Name,Hazard(lass,ID Number, 10.Containers 11.Total 12 U* 13.Wa*Codes <br /> and Packing Group(If any)) too. Type Quantity WtAfd <br /> 0 <br /> ri <br /> is r <br /> Z. r <br /> 3. 0 6 2014 i <br /> t <br /> - s k <br /> 4. <br /> DEPARTMENT I , <br /> . r <br /> 14.Spactal Handling-lnshadinm andAdditianui information <br /> 1-8{.;1-�r;t -9� fd:..st23'#&a;;:L7:t PFS? L�#Et _1k S ;3 <br /> SOLIDS z F Cg-A--U0iv9?'3S s Ai'P,ROPR1A i E PERSONA` <br /> 15. GEN6RMMFVVOFFER0n CEnRCATION:I hereby dedare Slat the c0ntrts Of eft ate fury and accurately described above by the proper st It ex name,and are d I amad,packaged, <br /> marked and labetedlplacarded,and ate in aU respects in proper arraflnon for Itansport awOMI tg to appitcabta International and national governmental regulaf�ru tf expert sit pmenI and I am the Primary <br /> Exporter.I cer*that the conlants of itis consignment oxiotm to the tetras of Ta attached EPAAdmmvledgmant of Consent <br /> I certify that I,*%vast-mhmr!gtion statement fdantW in 40 CFR 2aZT(a)(Vt am a Wge gmthy generabr)or(b)(III am a sm quant ty generator)Is True. <br /> t s PimtadlTypad a <br /> Sig <br /> ..t 1fi.Intemaftona!SttiPmenis tnrgcrt�U.S. ❑Expartfrom U• Port of entry! <br /> Transporter s}gnatur-(htr exports only): Date la ". U.s_ <br /> �y��y,� 17.TranspotterA[�rn+rtedgmentofRooeiptotMatartars <br /> � T 1 Ptitrtsuiffyp(?d Srgna <br /> mom tSay year <br /> z Z Priv Nang <br /> Q <br /> 18.Discrepancy <br /> 1aa.Discrepancy Indication Space QuanSh ❑Tyke ❑Residue ❑Pallial f{ejection ❑Ful Rejecfion <br /> Manifest Re'orenw Number <br /> U.S.EPA 10 Nrnnbar <br /> 18b.Aftatttate Faddy tOr Gelletalor) <br /> v <br /> Fac3&Ya Pham: Montn Day Year <br /> tac.Signature of Alternate Facility(or Generator) <br /> Q <br /> z <br /> 55 19.Hazardous Waste Rept Atanagamant PJ�sUwd Codas(I e, for trazaldous k2sle haatmem disposal,and rerycla�g systems) <br /> G7 1' 2 <br /> 3 4. <br /> . <br /> 20.Dasklnalod F261h OyJitgr or Opmt�:CDltl'.4u` W QI rt 41 Of haZdttf9us rnateiaYs avmad by the rra3rttiest a ne as rrdod in Item 1aa Mordtr Day Y <br /> S � <br /> t-PA FimmST03-22(Rev.3-Dry pmvviaus diuomareobsolete. DESIGNATED FAOILITYTO STINATION STATE(IF RRQUIFtED* <br />