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Ferro A - i'ma" alProtectionAgency ....t.�- <br /> pprowd OMB No.2050-0039(E,pirn 9.30.99 O# J3�/f� <br /> iyoi�prin4ir ypp. Form designed far we on dib(12fplkh "im, See InstrUC tions On bock of <br /> ape b. <br /> _ Deportment of Toric Substances Canted <br /> UNIFORM HAZARDOUS erte'obrl US EPA ID No. Manifest Documem Sacramento,California <br /> WASTE MANIFEST z page 1 in —Ifw in me shaded areas <br /> / �J Z ^' i+wt raquird by Federel 6w. <br /> 3. Gened',b's Noms and Mailing Addre E ( J aF /e <br /> n <br /> t: <br /> / A,slate Manik,t Document Number <br /> iZa� srG� �4�,cz3 23496739 <br /> nd. Generear',Phone I t Q B. Stall Gin.w k.'+ID <br /> h5. Trwsporlsr I Company Name 6. UB EPA ID Number ' <br /> m EVERGREEN ENVIRDWMTAL t: 5 ab r an,p«ter,ID Re a cad l <br /> $ SERVICES to CAD 9 8 2,1411131216 2 0. Transporter',ph.. <br /> cp�g���pGR��� 510/795-4400 <br /> 7 � 1HAN.1riAi[L1'ION & B. UB FPA ID NumbeE. Slate Transporter',IDRI e e ad.p <br /> cyi MEDIATION, INC-. <br /> a CAD063547996 P. Tan,pe erS hes. <br /> �U 9, Designated Fociliy Noma and",Addi 10. US FPA ID Numbs <br /> �QC. Statef ili ID <br /> Ori 21ST CHNTRURY, off <br /> 2095 NEWIANDS DRIVE EAST H. F "Y" 7 <br /> ys Phe e <br /> �1 o FMMLY, NV 89408 N V D 9 8 0 8 9 5 3 3 8 775-575-2780 <br /> NU k*US DOT Descoinfion(including Proper Shipping Name,Nozard Class,and ID Numberl 12. Containers 13. Tool 1 1A, Unit <br /> Z No. T Ouser i Vii I. Waste Number <br /> 3, <br /> 06. EPaoh„ <br /> eti l <br /> 0 N b. g <br /> m E <br /> NR _ Eva/aper <br /> e A <br /> GT <. State <br /> m O <br /> R _ EPA/Olher <br /> Y <br /> � d. Slate <br /> Z <br /> W <br /> U EPA/OIMr <br /> W <br /> J. Addilional Desvlp8ons for Molerlols Utnd Above K. Hondlfng.Code.Is,Write U>ted Above <br /> Qa ��yo-oo - . O/ b. <br /> W lie <br /> W <br /> lid C. d. <br /> 0 ?5..Special Handling Instructions and Additional information .a B.R_CJ ] <br /> i 24 HOUR MMGENCY ODNTACT:PHILIP INC_/LRE SOARES 1 b_ / <br /> S WEAR PROTECTIVE CILYMING(&00 3) 21-1030 SITS: 1 11d_ <br /> EYIiWSAR <br /> =1 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consiggnn torefully and accurately described above by proper shipring rams ondae classified,packed, <br /> Vmarked,and lobeled,and are in all respwh in proper condition Fm transport by highway according to applicable international and narionsPgovernment regulations. <br /> If I am is I.B. anti War,I cerci that I have aproram in lace to rduu tM vduma and mi of cast+N generated ro the de I haw determined ro be economical <br /> B 9u 9 N p P y 9 R'ee y <br /> N practicable and that 1 ha a selected the practicable mxhad of treatment,storage, disposal currently available to me which minimize the present and Faure threat ro human fir <br /> and the emironmenl;OR,if 1 am a small quantity generator,I how made a good faith effort to minimize my waste generalist.ad select the best ware management method then is <br /> O evailab6 tome and that I can aFFord. <br /> ZPrinted/Typed Name SignaN.e Month Day Y. <br /> N r -7o <br /> W T 17.Tress Her nowindomeni Rin i I of Antedab <br /> 4RjPrind/T Signi M * Doy Y <br /> Is OW B <br /> O0 18. T r 2 A< owlei nI'PFKoeip1oFTAi <br /> j Primed/T - 1 Month Fay Year <br /> N MO <br /> V19. Discrepancy Indication Spon <br /> Z F <br /> A <br /> C <br /> I <br /> Fin At or octencon,C.04io.ti f notify,of hamrdo..malxialsBred s monife+l azc as nal Item 113. <br /> T Pri typed Noma - Si burs nth Ywr <br /> R <br /> DO NOT WRITE BELOW THIS LINE. <br /> White. TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A(1/991 _ To: P.O. Bow 3000, Sacramento, CA 95812 <br /> EPA 8700-22 <br />