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��" <br /> '�' <br /> ,ease mint or type lForm dem for use on efne(I 2-pitrh)typiewderr) Form Aorilroved CAO No 2060tiX19 <br /> =11 <br /> UMFORAI HAZARDOUS I I i5kniaraw U Hurnbor age I of 3 Energelix-1 Response Rwe 4.litwiftst frac"murnber <br /> WASTE MANIFEST 15114 - f 005888118 FLE <br /> I 1 17'175' I <br /> kAr*MV I r.,WR3 all;Mailing A4111IRM U&XlraWs SmAddrm(if ddWm Inas Inimitmig <br /> agorc*u) <br /> Lath & B013Y Not k= C' batrt bo(jV W(:j ).- <br /> #j L <br /> 5308 PACIFIC AVE, GHERWO13D MAL-L ' 5PPLE L 53U, PACIFIC RVE <br /> AGLIKTON, CA 951�0 STUCULT1. CA <br /> nvlr� parry Norm- <br /> US EPAUP4 <br /> US EPA 10 N~ <br /> Warldwide Recovery Systess <br /> AROOO 1754,22 <br /> -,ea'7B1EdFacftyName ane SftAWnns 'JUSa -1 e F-. t L <br /> U S EPA ID Nffril" <br /> L'7-30 j . I Ah Street <br /> Facdo-3 Ptiorie <br /> WR00015!5924 <br /> 9a Sto d S COT DmrptW(axkicing Proper ShopkV me",Hazard Class.11)Number, 10(:crdainers <br /> Htd W4 Paidting Group(I arty)? 11 RAW 12 Urd 13 Whste Lode--. <br /> rAt T)%X' LNmlfty ,A)[ <br /> on llqu—irl 3F Ooky-,W <br /> dol I-otions), <br /> LU <br /> LU <br /> 2 <br /> ai <br /> 14 SprXxal jnr Addftminal"o"Th"fim 1110'32"'St3te Regulated Liquids) <br /> 15 GENERATOR-vX*FEROR'SCERTFXATION:i hereby rie[5re t thr con(trt M ala ern siytrr rad are fully and a�atety descried Ly Iht1 Ptnper sfippng n�rre,and arc c axdod,packs _ <br /> '%Tked aAd;AdOdlP1amrd(4 and are it A ffmpects an piol;ercOncitor.or transport according to appicalNe m and natio em PU r09ALions ff eqart shpmerrl and i am the Pointarip <br /> Emporia(1(tftOY Mat MC cumlOnts cf'hs ECIrmlignotent t:"ftm to the 113m of fie attached EPAAck <br /> raMidgmen C nt. <br /> (b)(01 a-A"neratcr) msc <br /> tur'stIffmues PnrnedTj*Name— 5ogria ehal t Q r <br /> 16 <br /> Iwow Lu U 5 i,J E*c,ii.U S Pmt d <br /> Trans sign?lmira!Far!!� <br /> - ,Only). Dale <br /> U 17 Transpomt AcnovAod.7tan <br /> kt d Ramipt of Majuriah 7 <br /> = U <br /> W — ---- <br /> rM*ariew I Prvv�Tpe�NwW I <br /> Anthony Mack <br /> JJ <br /> Tminsporlor 2 Pvtoloo-Typud 14am S~- <br /> Cz <br /> 18a OisLircloanvi,Inckabon aoxe <br /> Ouarrhty .}T" Resits Piano Repdor FLA Resection <br /> US EPA IDP40jtot <br /> -j <br /> 0 <br /> LLA 18C S97ature of Abarmirtm Faahvj(our <br /> %lonn Day 'fear <br /> 19 Ha udetf ti. U Report Managorriml kktd3d Codes(i e.codes br ha-'ardour wqi4ft TMnWIL di%asw and roviciiing ayslem� <br /> LU <br /> - 14 <br /> 'D Dmimqmtod Farity Owner or Opeptpr CerWalian of receipt cd ha-,vdoug mas"tals rnwga 6y a1C marsica cxm as r j3ted <br /> p, in <br /> P. <br /> 1�pnjt- Da�- New <br /> Y-V\ <br /> HIA P(mr,8AYJ-22(Rev 3-05.1 PMvms Odtom are obw&ete <br /> I A';i A,,-1 T Y TO 7) S <br /> 87047 G 4 1 OfE I'S IT6 I zt 100773 M <br />