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Please print or type ® o o is-7 is 6 Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1,Generator ID Number 2.Pago 1 of 3,Emergency Response PhoneMarrlfast TrackiNumber SA" 1 R21 f. WASTE MANIFESTCAM2M2,5 013477420 F L E B.Gremrrator's Name and Mailing Address Generator's Site Address(if diffareN than mailing address) T 3i� AR1 C lel '13411�11I LM Willy Lod CA 9SU2 L04 CA 95242 Genofalor's Phorro2W-333,111M 29 2745 333-011M St 27M 6-Transporter i Company Name U.S.EPA ID Number RIMMId TrWdofMVlIRC IFLR000169203 7 Transporter 2 Cornpany Name U.S.EPA ID Number 8.Designated Facility Name arld Site Address U.S EPA ID Number 43(an Harbli r>f.ARA Emerald Tf IeI'1mw Las Angeles LLc) 5756 ARM Sbea Los k1da,CA M% Facility's Phan, 32-3-277-2500 ga, 9b.U.S.DOT Description(including Proper Shipping Name,Harnrd Class,10 Number, 10.Containers11 Total 12..Unit 13,Waste Cafes HM and Packing Group(if any)) No. Typo OuanBry WLNoI. QR_ -�-- - �''r �. W 'NON �s WAM UQUID 0 (Thn0bnw whit wpm PC%) coy LS 42 3UN231S Falyidl fir 9,lei 11 791 X ��-OR FIRed> P' 39 CM 109VI 4UNB1S, Ofi<l M*d ITS,�K 731 y del Epipment e 01 sled;>5*pm PUS) 3 CM 9 cf Id,Special Handling Instructions and Addllitraal Inform Ilan 3sxc� 171 41 )_3XCM Ernergen cy Reepom Contact,Emerald i"ra*tt�nrrne�r 15, GENERATOR'S70FFEROR"5 CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper conditk3n for transport according to applicable international and national governmental ragtitdttons_If export shipment and I am the Primary Exporter,I certify that LI-A contents of this consignment r:onform to the lamrs of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement idenfffied in 40 CFR 262.27(a)(if I am a targe quantity generators or(b)(if l am a small quantity generator)is true. Genergtor s ffem�s Printedrfyped Name Signature month Ray Year k an1 j 1)16.international Shipments FImport to U.S. Export from U. Pal of enlry7exit: ? Transporter signature(for exports only): Dale leaving U.S.: Ir 17.TransparterAcknowledgmenlo?Receipt ofMaterials LLJ TrnnSpor;er 1 PrintedT d Name S3gnalur. Month Day Year CL at"I lao 119 �E Transporter 2 Prinledffyped Nano Signature fvianih Day Year 18.Discrepancy 1$a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residuo ❑Frill Re)Ection ❑Partial Rerecfion Manifest Reference Number. 18b.A'v male Fadkly(or Generator) U.S.EPA ID Number U U- Facility's Phone: W 18c,Signature of Alternate Facility(or Gereralor) Month Day Year, 19,Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment.disposal,and recycling systems) 3.1 -9�1.j z. H141 H141 4 H141 20.Designated Facilil Owner or Operator:Cedifceron of receipt of hazardous materials covered by the manifest except as nailed Inam 18a PrintedlTyped Name SignatureJA J It F.1 111 flay Year EPA Form 6700.22(Rev.12.171 Previous editions are obsolete, OMMATE FACIA ITY TO EPA's e-MAN SYSTEM