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Please print or type(form!t4ned tar use an eke(t2-pitch}b1piewriter) Form ApprovM,MB No 205MG39 <br /> UwF:ORMw.,IAwUS 11 GeMaWID mum* e T of 3 Ert"ancy Response Phone 14.MarAd TrAdting NumbeF <br /> WASTE .jwgT COLOM90M =1 I S7-7577Z-663 - _ , 1 005888127 FLE <br /> 5 GerwaiVs Name aM MilingAftm C*rwaW6 Site Acidness(6 diffiarent t-an,mxluq address) <br /> victovja� z Seci et 114zi kIiLtG)-i5*1S &4ECt-et#114-j <br /> 2254761963 4950 Pacific Avenue, Space 425 4�5e Pacific Avenue <br /> Phone I-itocktan. CA ;&g2kton, A <br /> 6 Tr-ansp3w M—�Nam us EPA 0 NwrAw <br /> steriLvcle stiecialtv }da=te Eavlutions lln <br /> Ttansponer2 Company Name US,EPA ID Number <br /> Worldwide Recovery Systems M1754.?- <br /> aD-9r""Fa0u`Y'la-and�;-*AdE1r— '(Una YeE. LLC US EPA 0 Number <br /> 273V L. 13th Street <br /> 'Y"Ma. A2 85136! <br /> -F*rWsM*m A.ZRO 515924 <br /> 90 U S DOT Descnpbon 1 <br /> aft0r,PMW Shi"Name,HMM Class,0 NO , 10 conlimefs 11 Ttbl 12 UIrIft 13 Wast Codas <br /> HM MKIPOCIdnOMP03c'M No Type Quaray Wtft <br /> 'Non RCRA hazardous waste. liquid Ca <br /> ,5apz-. Z' CF <br /> w Own P -3 71 <br /> Lotions), x. <br /> LU <br /> 2 <br /> 4 <br /> 4 <br /> 41 <br /> 14 s 1. 11 0%2*t5tate Regulated Liquids) <br /> 15, GENMTOR WFFEROFrSCERnFXATXK- I hereby dedwe dost the owftnts of Mis consOwwrt are fully and a=rately desarlW abase by ft pope M#iV haft,and are clessitw,padoged, <br /> marked and and am in all respects in pmpBr condition for tmnspw amm*V to applinable interroonal X-4 naumal 9DVeM It e)w smpmalt and I an me NMMY <br /> EKPOft,I M*INOt ft ctiftft of ft CMVMmt=ftm to ft Won$Offt Attactied EFAAciciowledpiett of CorwM,,IN <br /> I ca*tM ft WaM#*4ftzallori Statement OMMad in 40 CFR 262 21(a)(it I am a lar"quantity p-rador)or(b)(if I aKa W4 won*=1 <br /> X-Mylied rep, an e' alf of Limite <br /> + 0. 11 1 "15 ki 11201 E <br /> 16 Intotnaw" <br /> imow to U S ❑EVM tIM U 5, Potof <br /> T r AnsP-W-- a N re <br /> 17 Trte RwW ol`MaAmiats <br /> TmspoM I Frime&Typed Name Day Vear <br /> Col. n <br /> Athortv Mack <br /> 07 r I Alt` 1 051 ¢;I I,-,j I E <br /> M TratspaAar 2 PanielTyped Name mom --M;�ew <br /> log IMI ARP <br /> 18,Docrepancy J, <br /> Ift,Discrepam:4 ImEficalion Space Type Portia R*O. FA$kWb. <br /> 6'm*--A Rdeffmce liumber. <br /> 18b Albamvlo Facility(or G JUS EF)kICD Wff*ff <br /> PhDne <br /> I&Signature of A#wM FwAy for Caremdtw) J&nth -75ij—Year <br /> 19 s 9u20 Repod Managemat MOMM Codes it e,codes for hanrdous WrA buhw*dspo",aod mcydng Fpigww) <br /> UJ 2 <br /> 10 Ax I <br /> L 24 Dasrgmled FmAty Owaer or OpFmq dmc*of hazardous fnatedais cavered by Ow manifiest wxept as rided in Iters <br /> 01 <br /> EPA form B700.22(Rev,3,05) Previous editions are Obsolele. DESMATM FACILITY TO DrSTINATM ST' TF(Ir nQUIRF-D) <br /> 6700-2011.2v,3 CW33378 541067702 041100774 M . PDCFJOIIB qD"118 <br />