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Stole of Coliforain—Environmemol Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9.30.99) See Instructions on back of page 6. Deportment of Toxic S.b,waco,Control <br /> PI¢bso print m type. Form designed for use re elite 112•pilchl ryinarrier. 5acromento,Calif.Into <br /> UNIFORM HAZARDOUS 1. Goncratofs US EPA ID No. Manifest Document No. 2. Pogo 1 Information in the shaded areas <br /> is not required by Federal low. <br /> WAST MANIFEST U I I of ' <br /> 3 . N d dmu A Stan Man fesl Document Number <br /> �:� v 6rt •"P wr ' <br /> B. State GumanioYs ID <br /> N 5.'11.4,UtAijaregife r - 6. US EPA ID Number C. Stale Tterspo noes ID 11howV .1 <br /> m <br /> D Tlpni 'ler Phones _r „. <br /> 7. iransportar 2 Company Name •B. US EPA 1D Number E. Siola Lanspo Mr s ID[Reserved) - <br /> 1 —r i r j '% (: r 'e' F. Transpodor s Phone - <br /> V 9. Designated Facility Nome.ad Site Address 10. US EPA ID Number GJ$tato Foc I ty'srlD <br /> ,r,) Q 1 _ i'E 1 r e• t - !r <br /> �+x•o, H Foc liys phone r' <br /> O <br /> 11. US DOT Description(including Proper Skipp!I,Name,Hozard Class.and ID Number) N Containers 13. Toms I A. Unit <br /> V N. TYPe Quantity VVI/V.1 1. Waite Number <br /> Z Stale <br /> 2;, I'f, lt`j 'ff � 5Mreolb-. (z1f'+' i� i;/IF '^�n �.! EP <br /> fc l: <br /> E b. <br /> o N <br /> m E <br /> R EPA/cher <br /> v A — --- <br /> 0 7 `' State <br /> m O <br /> R EPA/011ier - <br /> Fd. Store <br /> Z ( 9i R1 PffrRGvCm. wAm..wA5 RTsEFwm 14 kNOLED AN STORED MR SURSPOUPW )"III <br /> W DISPOSAI.'. LATPtENI OR IOSSB CROSBY UVER111M LVC UPFR ❑' 11 C F11 1111 L-!-1�. EPA/011ier ' <br /> V ( i't[N4fl'S fiSANTEU'I'O I1tEM.Py n03 UE}•Ag ME.'1 'T tC R N : P-Toi r';LiiIN <br /> N 1 IL t 11 M� r + � A <br /> J. AJrleiorwl Descriptions for Mvro wh VAeJ A6mm ��qg <br /> All tnku Above <br /> Z y� ^TI d�U;�+g1�l,„ ,�JMSERV TION HMO RECOVF,rtY Act,*' {9 7 I N A'. II d Y. <br /> „ s,j E (:t tf:'N .��# '.. - A1715'S'FATR R AIATitl3is cR61 RV a OV -it1N !IAS A P III!PE b ti: <br /> a. r itiR5UT2 TO ACC$pf THE R&4jwN jiA T{AND SIna WA E WXN it .,.:... <br /> ACCORDINGLY fd -- <br /> Q 15 l Hn SpeciGdll g hmtrwtmm and Additional Information <br /> Z r <br /> 16. GENERATORS CERTIFICATION: Ihereby declare that]he contents of1his con grate I are fully and accurately described above by proper shipping name and oreclassised,pocked, 4 <br /> Vmarked and labeled,and m PII rasped t proper condition for transport L•y highway according to applicable international and national government regulations. <br /> r <br /> If I or,o]erg¢....1ity gonewtor.1 certify that)have a Program in piece to reduce the volume ad:oxlcily of wast.genewted to the dogma I have determined to be economicolly R <br /> n pracicoblo and(hal I .,.,.]acted the pmcticabl.method of treatment,storage,or disPosa)currently available to me which minimizes the present and future Ihreot to human heoll <br /> U' and the environment;OR,if I mm a smell quantity gemrotor,I have made o good fault effort I.minimles my vrosM generation and select the best wast.management method Ihot is i <br /> Oavailable,to me and III.,I can.!Ford. <br /> } <br /> Prirutd4Typ.dNmzm Si,rature SignatureYear <br /> Z. <br /> W �17 Tronsp Icer 1 Acknowledgement of Receipt of Moleriols / <br /> w A P m¢d/Ty'o Name Sign t ,avy Month D y Year <br /> IIS u �. / .:.. da• - _. ci I r /r <br /> O0 19 Tle' ,poria 2 Acimealml orow of Rocvi t of Materials y _ <br /> I Pr 1Tyend No.,. <br /> Sign Ira f / �Mon[h„I I y i I ,Y <br /> wWs. p �� <br /> VQ � <br /> 9.'DIisEinlsan<y In<Lmaon 5paf¢ <br /> Z A <br /> — C <br /> i <br /> L '. <br /> ] 20 Facility Owner or Operefor CertRMat' not mem I.16...rdou,materials covered 6 Ili is,oucadetroxaWas noted in Tem-T9. <br /> p Priewd/Typed Name ( f• Signowre / - t / *rIh � <br /> Y e, / r p 'Day <br /> Yeo <br /> DO NOT WRITE B�KSW T LIVE. <br /> U ':PY ri w milts ,c DAYS, <br /> 1 : !I t I7fela0 It t tf.. <br /> DTSC 6022A II/991 D r ri, ,;y ,t l 1, ll'Sc r jo <br /> EPA 5700-22 ' <br />