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Wks <br />MASSYft__6W_' <br />LAND DISPOSAL RESTRICTIONS <br />& CERTIFICATION FORM <br />Generator Name Applied Aerospace Structures, Corp. <br />Generator Address 3437 S. Airport Way, P.O. Box 6189 <br />Stockton, CA 95206 <br />Shipped To <br />Address <br />Pollution Control Industries <br />11855 White Rock Road <br />Rancho Cordova, CA 95670 <br />Generator EPA ID No. CA0009189069 <br />EPA ID No. <br />CAD980884183 <br />Manifest Doc. No. qa 97-5— <br />State Manifest No. Iq <br />ani es a' .�.L� Non -Wastewater EPA Waste Codes° <br />e to wastewater ❑ Labpack <br />Hazardous Constituents Contained In the Waste <br />Subcategory <br />" <br />Avg % Min % Max % <br />Certification Statement <br />an est'age Non -Wastewater EPA Waste Codes` 7'6} ' <br />p e A Wastewater Labpack Subcategory <br />Hazardous Constituents Contained in the Waste Avg % Min % Max % <br />Gertification Statement <br />_Wt <br />� <br />anI a aP e 't Non Wastewater EPA Waste Codes �(i�Ql <br />�ne tem � wastewater Q Labpack Subcategory <br />Hazardous Constituents Contained in the Waste Avg % Min % Max % <br />Certification Statement <br />I hereby certify that all information submitted on this and all associated documents is complete and accurate to the best of my <br />knowledge and information. <br />Generator Signature Title Gi l!_'��?ti� ') <br />--- - <br />PrintedName t ,,; Date 3 Ay /dj <br />