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Please pnnt or type (Form dos!i nod for use on elite 12-pitch)typownler) Form Approved OMB No.2050.9039 <br /> UNIFORM HAZARDOUS 1 Gorwntm in Ffumtef 2 Page 1 of 3.Emergency Response Phono 4.Windom Traching Number <br /> WASTE MANIFEST G B F <br /> 5 Cionora". 's Name and Marang Ad!1res, Ger"net SAe Address pf different than mM6ng addres,l <br /> MW1"TWOW.kV. 10342 Trio*Pkwy. <br /> M00 UK Croak Rd.,Sftnr W,M.CA 9621f SkVMW.OA 066210 <br /> Gur�ralkr's P"r '6" <br /> 111919 X742 <br /> " ,—Cr'Nr6 US EPA 10 N,rbw <br /> Lw s f6rrlM 2 Cryn('9ny Name US EPA 10 Numter <br /> W I E wV 5 rtZQ4 S AJC' I CA0001-75422-1 <br /> 3 Dos 3nated Facility Nano and S4e kkl, s, US EPA 10 Number <br /> Yum.YES Tlrwwbr F <br /> 2130 E I M at.Yuma /1 x6365 AT110006,602♦ <br /> FaaU s phone tib-}4�oaja <br /> Waste fbdn, <br /> tla <br /> 9b U S.DOT Dwr"on(nck4ing Proper Sh moa Name.Hazard Gats 10 Number. 10 Con niters ,I Two 12 Unit 11 <br /> H!.f and P6 isnig OW(it ary)) No Type Ouarbly Wt,%IrA <br /> 1 <br /> o NO"CRA H+ W"A W+440 SOW 3 p ---- - -- <br /> AbowbooW oris wiw Od <br /> w <br /> 2 2 <br /> W <br /> 3 I <br /> 4 <br /> ,4 Sf,nonl flwvlol, in,trulbons andAddlbmat InbnrAtum <br /> ProYa d ,.�t�'C)) 1 7 <br /> W0 kY2Z0 <br /> GENERATOR'81OFFEROR'S CERTIFICATION: I hereby dodare that the ocn nts of vut unWment are fully and accurately deunbed above by rrA proper"pa!g nacre,art aro di red.padKagad. <br /> r,aded and Isbeled'plaarded,ad are in al respects In proper condluon for transport WxVdng to KOeable ntomaoorel and nat"I gc,Ommenai rmutst»ro H export Stvpmorl a d I am ee Prlmsry <br /> E Kporter,I cer,4y that the contents of this consownenl oontpfm to Ire terns of the attached EPA AUnowredpmenl d Consent <br /> { VKO waste mln6mltabon statement Idv*W-n 40 <br /> CFR 262 27(a);if I em a Wp quar9, a2EJ or(b)(I I arri uanLKy gars eta)is true <br /> Year <br /> Z` <br /> 16 In gat.uKal,hprrena ❑ .n .exi _..__ ._._...... <br /> Import to U 9 F u u S Pod of enuy� _ —_- <br /> Transporter vgnaMs(for expora only)' Data W"U S <br /> swoC 17 Transporter Achntrrled;ment of Remo d Matonals <br /> Tr;Fo�1�7 <br /> ^ ^_ Si?alum — Mnnth Day 1yoor <br /> /rbwi `�,ltf' a month Day Year <br /> Z Tran%;artor 1 P 'ad yyed NenM <br /> UCo 3 <br /> t8 Dtcrngaincy <br /> M Discrepancy Indkebor Spacen Guenllry U Typo ❑Rovdue U Parlau Refection L i Ful Reledon <br /> Mantles)Reforonce Numbr+ <br /> !Sb Alternate Fooley(or Generator{ US EPA 10 Number <br /> U <br /> CFadityrs PNxm Month Day Yew <br /> W 18r. Signature osmate M(of GerwaW <br /> L <br /> z <br /> z <br /> e,- 1 a Hazardous Waste Ropat Management Method Codes(1 e,coda The hazardous waste lroatmanl.dloPO".AM rocycfrq systems) <br /> W 1 4W l I 3 a <br /> O <br /> I I <br /> .''i Designated Fadiby Owrw&&q Operates.Car"cabon of recelpl of hazardori materais ca orad by c w mandest except as Med in Ilam 16a Z <br /> flonl. ypod Nameignature Mcn d oar <br /> c u (—/Alu��rteOAF-/ <br /> E r'„Ft rm 8700.22(Rev.3-05) Previous editions are obsolete. <br /> DESIGNATED FACILITYTO DESTINATION STATE IIF REQUIRED► <br />