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se print or type. (Form designed for use on elite (12 -pi! )riyk <br />UNIFORM NA7AR000S i. Generator ID Numbers <br />WASTE MANIFEST <br />5. Generators Nema and t4slingAddress r'd <br />S#erreOLTaint!Cr rnatcit <br />23402 1>11rkim Chole <br />(,ap <br />10101niasbW Ch. <br />h .1 <br />-' - U.S. EPA ID Number <br />Y-,",;ri ry'ifnyfcio <br />of Y:crlr4 <br />F <br />9 If ,f!T_ 351 3'7(y V:1rOi illi CA 956$' <br />D70escdpfion (Including ProperSMpping Name Hazard Class, ID Number, i �?1',I`rsr t <br />ing Group(ifany)) 10. Containers it. Totol 12 -Unit No. Type Quantity WUAII, <br />q., lvAzzla> ASH1 srofS 9 1 c;ur <br />No. <br />13. Waste Codes <br />`'=f'.4'•f#egiorrl?� B$�Q��iJ_ 9:59 E11iS 54rezi ' <br />dere ltalwiuro, CA 941095 (415) T71-6660. Aste6,rm V,4jrppDvral Y CgNdremuln <br />61, (BlIgged„ sealed, lftbele& <br />15. GENERand RFFlet /OFFEROR'S CERTIFICATION: (herebydectsoper co dlimn f contents of Ibis wnsignmenl are fully and accuratslydescdbed above byfheproper shippingname,andarecl ssified,packaged, <br />marked and Zany that <br />onleandaremallrespells In proper condition(or transport according 10 applicable Intematlonaland nalional governmental regulations. If export shipment and I am the Primary <br />Exporter. Icertifythat thecontents of thisconsignment confomr Io the terms of the attached EPAAcknowledgmeol of Consent. <br />cediry that the waste mtnimizagon statement Ideal in 40 CFR 262,27(a) (if I am a large quawky generator) or (b) (itI am a small quantity generator) is two <br />Generalofs101femr's Prinled7lyped Name / <br />„9 �c Signature � Month Dey Yr <br />", C,+' sa ..h s �`j J %j7 ��'^Kf . .e','✓,.�°®JY,.",�.,i <br />16. Intemalional Shlpmenls <br />El Import to U.S. <br />Transporter LJ Export from U.S. Port of enlTransporter slgnalure (for exports only): <br />I I — Date leaving U.S.: — <br />78. Discrepancy <br />78a, Discrepancy lntlicallon Space <br />QuandtY TYPe - _ _ QResidue <br />, ..._. _.... <br />19. <br />aus Waste Report <br />led Facility Owner <br />'d Name <br />Cenificallon <br />vreste treatment, <br />materials covered by the manl(esl except as nded In Item 18a <br />U Pad�alftejeclbn ❑Full Rejection <br />lJfmx�"nl6'anit;l"k"�i�i'r�•I;CII�I'iYT'f� Ca�h1FeY3f1"i'CJ(� <br />