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Form Approved OMB No-2050.0039 <br /> Please pri�I_^r type. <br /> 1.Generator ID Number 2-Page 1 of 3.Emergency Response Phone 4.Ma019699594 <br /> fnilTest Tracksin�g Humber (;1� I V <br /> UNIFORM liA7ARf]DUS �.W1J71Ti�3n8r?s '"�UB = 0 19 6 9 9 5 5`r Ju K <br /> WASTE MAN IFFST <br /> 5.Generators Name and MailingAddress �; Generator's Site Address{il ditlerenI Than mailing address) <br /> S�EELrC±I {rYt�:�lTFSAi=T�`=:.1_ <br /> 2L T}k7 fklrlLr CJG L'rRVE L- i;?= i•-_F_- <br /> istUST-P:TIh1E,=sF'-. ��fFl ---. }-::;.�..,:i•. ,.. _ --` -'- <br /> 553_252,S217 <br /> Generaloft Prim: <br /> U.S.EPA fp Number <br /> 6.Transporter I Company Nome i1LE4ldTEt-H i fv'•:'1F+'iElilEfiT -L CnLI003304LS,- <br /> U.S.EPA ID Number <br /> 7-Transporter 2 Company game <br /> 8.Designated Facility Name and Site Address U.S.EPA IQ Number <br /> r-LEANT ECH EWtFcONMEP]T.yL Ii'rl :. a�r]J�',a�-• <br /> 5820 MARTIN ROAD <br /> IRWOIDALE,CA_ 91706 LS-zz <br /> Facility's Phone: 821 c^-7z�Cr <br /> ga 9b.U.S.DOT Description(including Proper Sfiipp rig Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Godes <br /> HM and Packing Group(PI any)) No- Type Quantity WI Nol. <br /> r -1 <br /> W <br /> 2 I<l0lU-RCRA,t'tj•sZ-4RD 0U5'uVAZTE S_FLIM 01 LY St 1-, I WAS T E X'-�:E � F a <br /> MET..L01L Fl1_TER '? y <br /> 3. <br /> 4. <br /> 14.Special Handling InstrucWns and Additional information ) <br /> LIS E GLOE�IE4iNC]GmS7t='� TF ISL K I I � <br /> 16$] (1-AETALFILTEF-1-3 <br /> C.,q LER l' UGT;DEI ITIFY C-LP—kki T E-GH EN.V RONM511T-AL AS RFGISTF,AIT: INFOTr`AG 800-535-505 <br /> 15, GENERATOR'SfOFFEROR'S CERTIFICATION; I hereby declare that the conlenls of this consignmgni are fully and accurately described above by the proper shipping name,and are dassiHed,packaged, <br /> marked and Inbeled(placarded,and are in all respects in proper eandiODn for transport according In appltcable inlemation at and national govemmental regulations.11 export shipment and I am the Primary <br /> Exporter,I cerlilly that the conlenls of this consignment conform Iv the terms of the attached EPA Acknpwledgmem 01 Consent. <br /> I certify That the waste minimization statement Identified in 40 CFR 252.27(a)(if I am a large quantity gsneramr)or(b)[if I am a small quantity generator]is We. <br /> GeneratorsloOemes Pdntedffyped Name Signature tAonth Day Year <br /> J 16.Inlemational Shipments ❑Import to U.S. ❑Export from U.S. Port of entryloxib <br /> ? <br /> Date leaving U.S.' <br /> Transporter signature{for exports only): <br /> Ce 17.Transporler NoknoWedgmenS of Receipt of Materials <br /> LU <br /> Transporter i PrintedlType Nae Sign h'onlh Day Year <br /> 0 rail 1� <br /> 'jo 5 ore Monlh flay Yca. <br /> CIO <br /> Transporter 2 PrinlecIrrybed Name <br /> r <br /> I&Discrepancy <br /> 18a.Discrepancy indication Space Quantity ❑Type ❑Residue Lf Pial Rejec:[inn ❑Fult Rejection <br /> ManifestRelerence Number: <br /> U.S.EPA 10 Number <br /> 1 Bb.Aitemale Facility(or Generator) <br /> J <br /> U <br /> w Fadity's Phone: M,nth Day Year <br /> Lu 1Sc.Signature of Alto mate Facility(or Ger eralor) <br /> a <br /> 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardcas vraste treatment,disposal,and recycling systems) <br /> urns 3. 4. <br /> 0 1i4ol. D 2. <br /> 20.Designat d FacElity Ovrrtaror Operaty Certification of receipt of ha rdous materials covered by the m i i aac0 as nded in item 18a Month Qay Year <br /> Print ped S: a e I {Q <br /> r TCI 1'"] <br /> EPA F 87f]D•2�(Rev,12.17W,1111U ditions are oWolete. DESI A CILITY TO EPA's e•MANIFEST SYSTEM <br />