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Please pont or type.(Form designed for use on elite(12-pitch)typewriter.) No. 0039 <br /> UNIFORM HAZARDOUS '- ;eneratorlDNumber 2-Pap 1 of 3.Emrgency Response Phone 14.Mantfest Tracking Number <br /> (9 0 0 24-9-.1 010 <br /> WASTE MANIFEST C.4 L 0 0 0 13 2)6 4 E, 009890669 JJK <br /> 5.Generators Name end Wfiq Address Generator's Site Address Of cifferervit than malting address) <br /> Ir-, LLI BE#2322 <br /> t: _e <br /> 500 E-KE'7TLEXAN '101. <br /> -4 <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name U.S.EPA to Number <br /> C8jD <br /> A89URY C-MYRCINMER-1.AL SERYTi'CES OCT 2 3 2014 <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> S.Designated Facility Name and Site Address ENVIRGINAAEN'Al HpAt—TH U.S.EPA ID Number <br /> ' <br /> DEPARTN`,`[7NT <br /> T 5-�Z- TH 130 Y L E A V E N VE <br /> LOSANGELES - CA SjJ1y =i 1 i1 i- A009�0- 09r- 7 <br /> J <br /> FacillYs Phone: <br /> " <br /> 9a. 91b.U.S.DOT Descrip0on(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit- 13.Waste Codes <br /> HM and Pacidng Group(If any)) No. Type Quantity WLAI& <br /> 452 <br /> 0 S <br /> Ce '4iZ,1j-RCP '. AZARDO,"S YOA-S SOLID COILY <br /> A q <br /> 2 <br /> Uj . <br /> CD <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> rt-=RG-#81 B1 171 FILE E 17- <br /> EMERGENCY CZ114TACT-.C�iE;T-fiiREC 24- <br /> IVE E U 179M. E N <br /> SQLIQ-�i t�- KWA-1�1015ci25�) APPROMATEE PERSONA` Q, <br /> 15. GF ----&i64nent are fd�and accurately desalted a by the pmper shipping name,and am classffied,packaged, <br /> NERAMFVSj0FFER0IrS CERTIFICATION:I hereby declare that the contents of INS <br /> marked and labeled1placardled,and are in 2U respects In proper condition for transport a—riling to applicable international and national governmental reguiations.if export dipment and I am the Primary <br /> Exporter,I certify that the contents of this consignmerit conform to the term of ftn-attached EPAA*awledgmant of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(If I am a targe quantity genertbor)or(b)(dl am a sin quantity generator)is he. <br /> �s Printed[Typed a 'Y'a- Y7 <br /> -J 16.International StlipmentsImport to U.S- <br /> Export f.U. Port of entlw� i7si <br /> Date le U.S.: <br /> Transporter signature(for exports 0111V� Dat"a U.S <br /> 17.Transporter ACIMUWL-dgment Of RMIPI Of Materials a <br /> porter 1 Pdntadayped S gni <br /> Month Day Year <br /> I spinner 2 PrinitRrhy�e—dl,larne <br /> tansp&W 2 I'd <br /> ' tt <br /> t 18.Discrepancy <br /> I18a.Disaepancy Mirabon Space Quantity El Type ❑Residue El Partial Rejection ❑Full Rj..h,n <br /> Marflfest Reference Number. L.I.S.SPA to Number <br /> IBb.Alternste Fadrfty(or Generator) <br /> lei FadTVs Phone: Mortttt—Day Year <br /> C2 <br /> uj 18c.Signature of Allem ite Facility r) <br /> 19.Hazardous Waste Report Management Method Codes fi.e.,codes for hamudous waste treatment,disposal,and recycImq Systems) A <br /> LILI 2. <br /> as noted in Item 18a <br /> 20-Designated Facifty Oner or Opu;�w.Cffof MMpj of hazardous materials covered by the manifest 1 Mrffi Day <br /> Print F-1 1)71 <br /> EPA Form 8700-22(Rev-3-05) Previous editions are obsolete. DESIGNATED FACILITY TO STINATION STATE (IF REQUIRED) <br />