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a of California—Environmental Protection Agency <br /> n Approved OMB No.2050-0039(Expires 9.30-99) See Instructions on back Of page 6. Department of Toxic Substances <br /> iM print or type. Form designed for use on elim 112-pitchl typewriter. Sacramento,California <br /> I Generators US EPA ID No. Manifest Document No. 2. Pa 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS ee is not required by Federal law. <br /> WASTE MANIFEST ., r " of <br /> C»neroro' c/an 1.laili.,,ed s/ <br /> 'y State Manifest Document Number <br /> 21750975 <br /> ''}},,r r'^ B. State Generator's ID <br /> 4. Gane rdrtoi�iN'hanel('��1� �� !y 7P <br /> r i <br /> 5. Transporter 1 Company amu' - ts� 6. US EPA ID Number C. State Transporter's ID[Roserv._.I <br /> LW s DIII 1;62 <br /> 4 1113 e D. Transporter',Phone i <br /> 7. Transporter 2 Company Name 19 2 <br /> 8. US EPA ID Nember i E. State Transporters ID[Reserved.] <br /> F. Transportar'a Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Sea,Facility',ID <br /> 1021 ICS t�?N ?ltffC {t A D 9 $ S i ! M 1 0 <br /> 1�1:ikif+J"hub' i .) H. Facility's Phone <br /> —IM&ALU512 1111s 1Ax a i a iia <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> No. Type Quantity Wt/Vol I. Wast.Number <br /> a. <br /> S <br /> .Sbil1 cRS E� <br /> E n <br /> N b'fyrP7M,li ./I C' i01 AJOS surto sT1 <br /> AA fN f� I Q r f / EPA/Other <br /> T - A <br /> stat. <br /> O <br /> R EPA/Other <br /> d. <br /> State <br /> EPA/Other <br /> J. Add eonal Descriptions for Materials for <br /> isle l Above - <br /> 15. Special Handling Instructions and Additional Information - <br /> 24 Kahn PLY Rapow Td.k 08M 14"4-M <br /> DIN� 'Waaf P09COW fdii!of Ledirg� rp�y� � i <br /> sales Order# <br /> 16. GENERATOR'S CERTIFICATION: Iheraby declare that the connof this consignment era fully and accurate)y described above by proper ship Ing name and are classified,packed, <br /> marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and nationaPgovernment regulations. <br /> If I am"large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated ro the degree I have determined to be eco <br /> nomical)Y <br /> Practicable and that I have selected the practicable method of treahnenh storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;me and tat I if am a small quantity generator,I have made a good Faith effort to minimize my waste generation and select the best waste Management method that is <br /> available ro ro and that I can afford. 9 <br /> Printgd'/9'j ed Name <4 "7 mr <br /> S� na .. - <br /> �......% 9 W,.... Ys7 Doy Year <br /> t 17. Turnsiter 1 ckn ent of Recur t of Merano), r r - <br /> Printed/TYpad 81' a r $ignaNroMonth Day Ywr <br /> I 18- Tram iter 2 Acknowled emenf of xei f of Materials <br /> Printed/Typed Nome Si .tore <br /> g" ay Ywr <br /> 19. Discrepancy Indication Space Month D <br /> I <br /> 1 <br /> rPinMdNTyp�.J <br /> ner or O ra—CeniRcation of recei t of hazardous materials covered b this manifest except as noted in Item 19. <br /> ame Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> 8022A(1/99) - <br /> 700-22 Yellow: GENERATOR RETAINS <br />