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Month ri 77 I <br />18 Miriam:my <br />Day <br />I I <br />180. DIsPePastaY Iltdtdon Spare 0Quantity DPardalriefedian El NU Rejection <br />Year Mt Day <br />Please pill tyfie. <br />GentratorMano: =Ma <br />Trantilertel 1 Company Name <br />Nader Biftrementil <br />7. Imparter 2 Company Name <br />FaollyategactrAddress <br />5360 Clew <br />ttestiegb CA NM? <br />Phone: <br />Six U.S. DOT Dosofylitm (Mem Pre*Si*etng Name, Itemd Cirsa;ID erHumb. • <br />and Paddng Grotto (d any)) • <br />. <br /> <br />167.;rir!7rii WirerSZ •Vrec 71:7;37- <br />U.S..EPA ID Number • . .47 <br />• C.Ak000160347 <br />.S. SPAM Namter <br />U.S. EPA If) Number <br />20463.6101 • • . cALovotp.o8,1 <br />10: Coritablers :lLlbIaI . IZkiIt. <br />Cluddlly • ' <br />Ve 0 <br />6P <br />. Stdpments <br />0 Upon b U.S. <br />Tatasportar &paha' (for expatts only): <br />17. TrawatesAcknowiedgment of Recelpt of Matottais <br />0 Evert from U.S. Port of oneyfa4 <br />Dale laming U.S.: <br />Manttest Number: <br />lab. Memo's Facty (or Generator) <br />Fesditee Pt= <br />18c. *nature of Animals Panel/ tor Generator) <br />U.S. EPA CD Number <br />19.1tuardous Waste Rd Management Method Codes (Le, codes for banardol03 waste teemed. (404 artd ri141 *terns) <br />20. Detdgrtated Fatity Operator. 0 receipt of matrials oteered try the rnantfest as In Item 18a <br />PtlextliTyped tken7 <br />/1/1) <br />EPA Form man (Rev. 12-17) PRAM ecrillone are obsolete. <br />Day Year, <br />I 5 <br />TRANSPORTER COPY <br />3. <br /> <br />3. <br />1 Prtntadilypod Name • <br />(.4 5', <br />Tronsportar 2 PrintediTyped Sarno <br />021380769 JJK <br />tEleneratoes Site =raw IP Maned than aleall stilton) • <br />3. Etnergefq RaaPortso <br />77 2 <br />Ifaa1 <br />Fom Apmvad. OMB N. 2.1130-003D <br />.;:1.0..bitsto Codes <br />surstre <br />UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />3. Pag ell of