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I <br /> P$e SE print or type <br /> UNIFORM HAZARDOUSt ' 9) Noriber Form Approved OMB No 2W-M39 <br /> WASTE MANIFEST 2 PaI t �' J E eRegi "? 4 Y Tradap Nunta <br /> f 10 <br /> r, GBF <br /> 5 Gene a ors NMv and Masng 1�drest" <br /> I ' 7- Ga+ea•_�rs S'a Adrtrss ( s ii+era Cr n <br /> f iA' / r VIP 01 <br /> IteGer>wraWs Prior* 5 L <br /> 6 Tranyrrner 1 Gorrgarry N —' <br /> us FPA 10 IArYrr <br /> WIN III. RLI' ER FECYCLING Arta" <br /> 36? OQ2 <br /> 7 Transporter 2 Cornparry Narrr- <br /> US FPAIDN~ <br /> 8 f?etgneled Facskty Nana and SAe AAfrtts <br /> K- WAGE - CRYRAI. CLEAN , LLC US. EPA IDNk~ <br /> {cs > 1Q0 c GnUNDAGE LN <br /> FauS ► Phone 3;!: -RJ. BkKERSFIELLI , CA M307 OkL0002825" <br /> ger 9b U S DOT Desagbon (ndudvq Proper Shggirg N", Kurd Crass, IO Nom, 10 Cantrzxn 11 Total t 1 lA W <br /> NM and Ps9mq Grail (d any)) 13 Waste Codes <br /> 1 <br /> No Type Oryanttt Wl Ak4 <br /> WWRCRA FAIADOUS MASTE 9DLIDS - - - - - <br /> 9 2 G, <br /> W <br /> c� <br /> �RECEIVEC - - - - <br /> 4 _ �_--MAS 2022 <br /> � - <br /> 14 SpemlNa , _ ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> IbE (is1VA tt_) dEU JV�, cI '( 11`%cCAUMN5 ROMP 4 <br /> IS GENERATOR'SJOFFEROR'S CERTIFICATION: I hereby dedare that the oonterds of this consignment aro fully and accurately described above by the proper shipping inane, and aro dasv%ed, packaged, <br /> marked and labeled ',1acaNM, and are in al respects in proper rand bon for transport according to appicable Inlernal.1onal and natanal governmental reguta!;ons II export shipment and I am the Primacy <br /> Export", I cedt, that tlx contents of this consxgnment con!orm to the terms of the attached EPAAcknowiedgmenl of Consent <br /> I ceabfy hal the waste m"mit 'ton statement rderibfed in 40 CFR 262 27(a) (d I am a large quantty generator) or (b) (d I am a savor!] quantity gencralor) Is true. <br /> Generators. Or.eroes Pnnted'Typed Name Sgna!use Mon!h Day Year <br /> ?_ <br /> 16 Inlemabonal Sn"m is <br /> ❑ Import to U S ❑ Export from U .S . Fort of entry/ext: <br /> Transporter sgintin• (fa exports only) Date leaving U S <br /> K 17 Transporter Acijm dyrrenl o( ReceV of Material <br /> Transporter I Pnnted'Typed Name L Sgnalu� �! Month Day Year <br /> Z Transporter 2 Prmledgyped Karni signatu e ) f hlonth Day Year <br /> 18 Miaepaxy <br /> iM Rsaepancy Indca!bn Space Ouanhty ❑ Type ❑ Residue ❑ Partial Refection IJ Ful Re,ec6nn <br /> >nS <br /> Manifest Reference Number. es . <br /> t8b. Alternate Fan6ty (or Generator) U.S EPA ID Numoreber Bial <br /> and <br /> LLUnbty <br /> Facility's Phcure San <br /> H18c Signature otMemate Faoiry (or Gencra!or) Month Day Year infer <br /> Q <br /> Z <br /> N19 Hazardous Waste Report Management Method Codes (f e., codes for hazardous waste bealmenl, disposal, and recycling systems) _ <br /> p 4, <br /> 20 Desgnaled Facility Owner or Operator CcrtSca!lon of rec6pl of hazard's mater a!s coffered by Ura mamfesl except as noted in Item 18a <br /> Pnnted?yped Name Signature Month Day Yezr ,, <br /> EPA Form 8740-22 (Rev. 12. 17 ) Previous editions are obsolete GENERATOR' S INITIAL COPY <br />